Background
Provider-entered indications for antibiotics have been recommended as a tracking tool
for antibiotic stewardship programs. The accuracy and utility of these indications
are unknown.
Methods
Drug-specific lists of evidence-based indications were integrated into an electronic
health system as an ordering hard-stop. We reviewed antibiotic orders with provider-entered
indications to determine whether the chosen indication matched the documentation and
whether antibiotic use was appropriate.
Results
One hundred fifty-five antibiotic orders were reviewed. Clinical documentation supported
the entered indication in 80% of vancomycin orders, 78% of cefepime orders, and 74%
of fluoroquinolone orders. The clinical appropriateness for vancomycin, cefepime,
and fluoroquinolones were 94%, 100%, and 68%, respectively. When providers chose indications
from the list as opposed to choosing “other” and entering free text, antibiotic orders
were significantly more likely to be appropriate (odds ratio, 5.8; P = .001) but also less likely to match clinical documentation (odds ratio, 0.25; P = .0043).
Discussion
Provider-chosen indications are, overall, an accurate reflection of the true reason
for antibiotic use at our institution. Providers frequently documented reasons for
fluoroquinolone use that were not among the provided indications.
Conclusion
Selecting an indication from an evidence-based list as opposed to free-text indications
increases the odds that antibiotic agents will be used appropriately.
Key Words
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Article Info
Publication History
Published online: May 31, 2018
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
