Patient Safety and Quality

Electronic order sets can help treatment conform to guidelines for antibiotic use after surgery

A 2002 Centers for Disease Control and Prevention (CDC) campaign to reduce surgical wound infections and antibiotic overprescribing stressed the need to give antibiotics 1 hour before surgery and then to discontinue the drugs within specific time frames depending on the surgery performed. Despite the campaign, a 2005 report found that these practices were not widely adopted. A new study from researchers at the University of Pennsylvania School of Medicine's Center for Education and Research on Therapeutics (CERT) found that implementing electronic order sets that adhere to the CDC guidelines was effective in raising the percentage of patients whose antibiotics were stopped appropriately after surgery.

The hospital that integrated the electronic order set in its computerized provider order entry system saw timely discontinuation of antibiotics rise from 36.8 percent of patients to 55.7 percent. The increase was greatest in cardiac surgeries, which saw an increase of 33.6 percent in timely antibiotic discontinuation. The order set did not allow physicians to override CDC guidelines. The only way a physician could continue a patient's antibiotics after surgery was to indicate that the drugs were prescribed as treatment for an infection. The authors suggest that technology interventions such as these are stronger than system alerts, which can be easily overridden.

This study was funded by a grant from the Agency for Healthcare Research and Quality (HS16946) to the University of Pennsylvania School of Medicine CERT. For more information on the CERTs program, visit http://certs.hhs.gov.

See "Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period," by Kevin Haynes, Pharm.D., M.S.C.E., Darren R. Linkin, M.D., M.S.C.E., Neil O. Fishman, M.D., and others in the March 2011 Journal of the American Medical Informatics Association 18(2), pp. 164-168.

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