1. Does the implementation of electronic treatment protocols improve adherence to empirical antimicrobial guidelines in the treatment of infective exacerbations of COPD? Mrs Sophia Conner, Ms Clare Colligan, Professor Alex Mullen
Introduction
The implementation of Hospital Electronic Prescribing and Administration (HePMA) has presented a unique opportunity to improve prescribing and enhance antimicrobial stewardship. Due to the rise of antimicrobial resistance (AMR) it is imperative that new strategies are developed and tested with the aim of improving antimicrobial prescribing. Despite the development and implementation of evidence based empirical antimicrobial guidelines within secondary care, antimicrobial prescribing remains poor.1,2 In order to address this ongoing issue, the advent of electronic prescribing and clinical decision support (CDS) presents a practical and powerful opportunity to help prevent inappropriate antimicrobial use and slow the further development of AMR.
Period 1
Period 2
p value
Course length (days): Mean (range)
6.8 (5-14)
5.83 (3-14)
p=0.952
Adherent to guidelines: n (%)
10 (19%)
26 (65%)
p<0.001
Justified non-compliance: n (%)
17 (40%)
2 (14%)
p=0.152
Length of stay (days): Mean (range)
4.64 (1-20)
4.48 (1-21)
p=0.3
Re-admission within 2 weeks: n (%)
2 (4%)
0 (0%)
p=0.411
Protocol used: n (%)
N/A
23 (58%)
Aims & Objectives
To evaluate whether implementation of inbuilt empirical treatment protocols can improve adherence to antibiotic prescribing guidelines with a focus on patients treated for infective exacerbation of COPD (IECOPD).
To evaluate the opinions of prescribers on use of the system.
Results
93 patients were included in the 25 week period; the protocol was used in 58% of cases post implementation.
Use of the protocol improved adherence to empirical antibiotic guidelines.
The compliance to empirical guidelines improved from 19% in period 1 to 65% in period 2(P<0.001).
The mean duration of antibiotic treatment was reduced by 1 day in period 2.
There were no patients re-admitted to hospital within a 2 week period in period 2.
The length of stay in hospital was largely unchanged between the two study groups.
The mean cost of treatment was £1.80 in period 1 and £0.79 in period 2.
The results of the questionnaire showed a positive opinion of the protocol from those who had used it although there was a low response rate (63%).
Methods
A single-centre one stage pre- and post cohort study was conducted. All adults admitted and treated for IECOPD were eligible for inclusion in the study.
The study extended over two time periods. The first (period 1) corresponded to the pre-intervention (baseline) period from 22/1/18-20/5/18. The second (period 2) corresponded to the post intervention period from 21/5/18-13/7/18.
Electronic protocols were created for 3 empirical treatment options- amoxicillin, clarithromycin and doxycycline.
In period 2, the protocols went “live” within the HePMA system.
Data was collected using electronic prescribing records and paper medical records. Opinions of prescribers regarding protocol use were collected using a validated questionnaire.
Results were analysed using SPSS.
Figure 3. Table of results summary.
Conclusions
Adherence to empirical antimicrobial guidelines improved from 19% to 65% (P<0.001). There was a small cost saving associated with protocol implementation.
No unintended consequences such as increased length of stay or increased readmission rates were observed.
Feedback from prescribers using the protocols was encouraging and no major barriers to use were identified. The development of further antimicrobial treatment protocols should not be delayed and as there is no cost implication for this, it would be negligent not to pursue this exciting opportunity to improve antimicrobial stewardship.
Figure 1. Screenshot of HePMA protocols.
Statement
Mode Likert Score
“I was able to find the protocol easily”
Agree
“The protocol was easy to use”
“I found the protocol useful”
Strongly agree
“The protocol saved me time”
Figure 2. Questionnaire results
References: 1. Braykov, Nikolay P et al. Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study. The Lancet Infectious Diseases , Volume 14 , Issue 12 , 1220 – 1227
2. Werner, NL, Hecker, MT, Sethi, AK, and Donskey, CJ. Unnecessary use of fluoroquinolone antibiotics in hospitalized patients. BMC Infect Dis. 2011; 11: 187