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Evaluation of a Second-Sign Process for Antimicrobial Prior Authorization.
Aimee M Dassner1,2, Jennifer E Girotto1,3,2
1Department of Pharmacy, Connecticut Children's Medical Center, Hartford.
Journal of the Pediatric Infectious Diseases Society
|April 14, 2017
Summary
A mandatory second-sign process for restricted antibiotics in a pediatric hospital significantly improved appropriate use. This antimicrobial stewardship program initiative ensured better drug selection without delaying patient treatment.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Health informatics
Background:
- A pediatric antimicrobial stewardship program (ASP) implemented a second-sign prospective restriction for broad-spectrum antimicrobials in January 2015.
- This initiative aimed to optimize the empiric use of specific intravenous antibiotics: ceftaroline, cefepime, fidaxomicin, linezolid, and vancomycin.
Purpose of the Study:
- To evaluate the effectiveness of a forced second-sign process within the electronic medical record as a pediatric ASP strategy.
- To determine if this process enhances the appropriateness of empiric antibiotic use.
- To assess if the second-sign process causes significant delays in initial antibiotic administration.
Main Methods:
- A retrospective before-and-after chart review was conducted from July 2014 to June 2015.
- The study took place at a 187-bed freestanding children's hospital, including specialized units like a pediatric intensive care unit and neonatal intensive care unit.
Main Results:
- Of 1178 identified orders, 389 met inclusion criteria. Vancomycin accounted for the majority (92%) of second-sign orders.
- Appropriateness of restricted antibiotic use increased significantly post-implementation (84.5% to 92.9%, P = .01).
- No significant difference in time from order entry to medication administration was observed between the before and after groups (median 184.5 vs. 174 minutes, P = .342).
Conclusions:
- Implementing a second-sign approval process for antimicrobial restriction effectively increases the appropriateness of antibiotic use in pediatric settings.
- This strategy enhances antimicrobial stewardship without negatively impacting the timeliness of antibiotic administration.