Hospital-wide Description of Clinical Indications for Pediatric Anti-infective Use

AbstractPurposeThis study is the first description of hospital-wide anti-infective use according to clinical indication for a pediatric hospital. Children's Hospital Colorado (CHCO) is uniquely poised to examine its anti-infective use after the implementation of provider-selected order indicati...

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Bibliographic Details
Published in:Clinical therapeutics 2019-08, Vol.41 (8), p.1605-1611.e0
Main Authors: Williams, Manon C., MA, Obermeier, Haley, Hurst, Amanda L., PharmD, Saporta-Keating, Sara R., MD, Pearce, Kelly, BA, MacBrayne, Christine E., PharmD, MSCS, Child, Jason, PharmD, Parker, Sarah K., MD
Format: Article
Language:English
Subjects:
Ampicillin
Anti-Infective Agents - therapeutic use
Anti-infectives
Antiinfectives and antibacterials
Antimicrobial agents
Antimicrobial stewardship
Bacteremia
Cefazolin
Ceftriaxone
Child
Children & youth
Clinical indications
Codes
Diagnosis
Diagnosis related groups
DRGs
Drug dosages
Drug stores
Editing
Electronic Health Records
Electronic medical records
Feedback
Funding
Hospitals
Hospitals, Pediatric - statistics & numerical data
Humans
Indication
Intensive care
Internal Medicine
Medical Education
Pediatrics
Pharmacists
Prophylaxis
PSOI
Sepsis
Sinusitis
Target recognition
Urinary tract diseases
Urinary tract infections
Urogenital system
Usability
Vancomycin
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Description
Summary:AbstractPurposeThis study is the first description of hospital-wide anti-infective use according to clinical indication for a pediatric hospital. Children's Hospital Colorado (CHCO) is uniquely poised to examine its anti-infective use after the implementation of provider-selected order indications (PSOIs), which are distinct from Diagnosis Related Group classifications in that they are used for clinical treatment as opposed to final diagnosis codes for billing and thus are more granular. MethodsThis study used our institution's mandatory PSOIs to describe overall clinical indications for anti-infective use. For 2016, all anti-infective orders were extracted from the electronic medical record (Epic), including drug name, route, prescribing unit, and PSOI. We calculated the number of times each drug was associated with each indication and the number of times an indication was attributed to each drug, and then analyzed these data in Excel. FindingsThere were 29,258 orders at CHCO in 2016 with at least 1 indication. The most common clinical indication was “prophylaxis–medical/surgical,” accounting for 23% of all orders and commonly associated with cefazolin (42% of prophylaxis–medical/surgical orders). This was followed by the indications of “sepsis/bacteremia” and “pneumonia/sinusitis.” The most commonly prescribed anti-infectives for nonprophylactic clinical indications were IV vancomycin (14%), ceftriaxone (11%), and ampicillin (6%). ImplicationsKnowledge of the clinical reasons for hospital-wide anti-infective use enables hospitals to identify targets for improved use through education and guideline and policy development. This description provides better details than billing codes about the clinical reasons anti-infectives are used and offers a useful template for implementation at other hospitals.
ISSN:0149-2918
1879-114X
DOI:10.1016/j.clinthera.2019.05.008