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Reducing co-administration of proton pump inhibitors and antibiotics using a computerized order entry alert and
Christopher E Kandel1, Suzanne Gill2, Janine McCready3
1Department of Medicine, University of Toronto, Toronto, M5S 1A8, Canada.
Background:
Antibiotics and proton pump inhibitors (PPIs) are associated with Clostridium difficile infection (CDI). Both a computer order entry alert to highlight this association as well as antimicrobial stewardship directed prospective audit and feedback represent novel interventions to reduce the co-administration of antibiotics and PPIs among hospitalized patients.
Methods:
Consecutive patients admitted to two General Internal Medicine wards from October 1, 2010 until March 31, 2013 at a teaching hospital in Toronto, Ontario, Canada were evaluated. The baseline observation period was followed by the first phase, which involved the creation of a computerized order entry alert that was triggered when either a PPI or an antibiotic was ordered in the presence of the other. The second phase consisted of the introduction of an antibiotic stewardship-initiated prospective audit and feedback strategy. The primary outcome was the co-administration of antibiotics and PPIs during each phase.
Results:
This alert led to a significant reduction in the co-administration of antibiotics and PPIs adjusted for month and secular trends, expressed as days of therapy per 100 patient days (4.99 vs. 3.14, p < 0.001) The subsequent introduction of the antibiotic stewardship program further reduced the co-administration (3.14 vs. 1.80, p <0.001). No change was observed in adjusted monthly CDI rates per 100 patient care days between the baseline and alert cohorts (0.12 vs. 0.12, p = 0.99) or the baseline and antibiotic stewardship phases (0.12 vs. 0.13, p = 0.97).
Conclusions:
Decreasing the co-administration of PPIs and antibiotics can be achieved using a simple automatic alert followed by prospective audit and feedback.
Insights
Computerized alerts and stewardship programs effectively reduced the concurrent use of antibiotics and proton pump inhibitors (PPIs). This intervention did not impact Clostridium difficile infection rates, highlighting the importance of judicious medication co-administration.
Area of Science:
- Clinical Medicine
- Infectious Diseases
- Pharmacology
Background:
- Antibiotics and proton pump inhibitors (PPIs) are linked to Clostridium difficile infection (CDI).
- Reducing concurrent use of these medications is a key goal in patient care.
Purpose of the Study:
- To evaluate the effectiveness of a computerized order entry alert and an antimicrobial stewardship program in reducing the co-administration of antibiotics and PPIs.
- To assess the impact of these interventions on Clostridium difficile infection rates.
Main Methods:
- A prospective study was conducted in a teaching hospital involving two General Internal Medicine wards.
- Interventions included a computerized order entry alert and a stewardship-initiated prospective audit and feedback strategy.
- The primary outcome measured was the co-administration of antibiotics and PPIs.
Main Results:
- The computerized alert significantly reduced antibiotic and PPI co-administration (4.99 to 3.14 days of therapy per 100 patient days).
- The subsequent stewardship program further decreased co-administration (3.14 to 1.80 days of therapy per 100 patient days).
- No significant change in Clostridium difficile infection rates was observed between the baseline and intervention phases.
Conclusions:
- A simple computerized alert, followed by prospective audit and feedback, effectively reduces the co-administration of PPIs and antibiotics.
- These interventions are valuable tools for antimicrobial stewardship and improving patient safety.
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