Appropriateness of Intravenous Antibiotics Prescriptions at Hospital Discharge

Not Applicable

Completed

• Conditions: Anti-Infectives Adverse Reaction
• Interventions: Procedure: ID specialist approval

• Registration Number: NCT03173768
• Lead Sponsor: Chiang Mai University

Brief Summary

A quasi-experimental study was conducted among patients receiving care at the medicine units of the Maharaj Nakorn Chiang Mai Hospital to determine the appropriateness of intravenous antibiotics at hospital discharge with and without ID consultation.

Detailed Description

The pre-intervention period was started from November 1, 2015 to April 30, 2016 (6-month period), in which the intravenous antibiotics at hospital discharge were prescribed by the primary care team. The post-intervention period was started from May 1, 2016 to February 28, 2017 (10-month period), in which the intravenous antibiotics at hospital discharge were reviewed and intervened by ID team.

The appropriateness of intravenous antibiotics was assessed separately by the ID fellow and ID specialist. If disagreement occurred, the feedback to the ID fellow was performed and the decision by ID specialist was used in the final analysis of appropriateness.

In post-intervention period, ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics

Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.

Study Timeline

• Study Start: 2015-11-01
• Primary Completion: 2017-02-28
• Study Completion: 2017-02-28
• Study First Submitted: 2017-04-03
• Study First Submitted QC: 2017-05-30
• Status Verified: 2017-06
• Last Update Submitted: 2017-06-01
• Study First Posted: 2017-06-02
• Last Update Posted: 2017-06-05

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 173

Inclusion Criteria

All adult patients who met the following criteria were consecutively enrolled;

1. age≥ 15 years old and
2. had infections at any sites and received intravenous antibiotics.

Exclusion Criteria

• They were evaluated by infectious diseases specialist for appropriate antibiotics during admission

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
post-intervention period	ID specialist approval	The intervention is the charts of patients who were prescribed intravenous antibiotics at hospital discharge by the primary team were prospectively reviewed and intervened by ID team (ID specialist approval)

Primary Outcome Measures

Name	Time	Method
The proportion of appropriateness of intravenous antibiotics prescriptions at hospital discharge between groups	16 months	To calculate the number of antibiotic prescriptions at hospital discharge over the total number of prescriptions, comparing between pre-and post-intervention period.

Secondary Outcome Measures

Name	Time	Method
The costs of antibiotics for the course of treatment	16 months	To compare the cost of antibiotics for the course of treatment between the 2 periods
Readmission within 30 days, length of hospital stay	30 days	To calculate the number of patients who were readmitted within 30 days over the total number of patients in each period, comparing between the 2 periods
Length of hospital stay	60 days	To calculate the length of hospital stays in days between 2 periods
Clinical improvement at 1 week	1 week	To calculate the number of patients who had clinical improvement at 1 week over the total number of patients in each period, comparing between the 2 periods

Trial Locations

Locations (1)

Department of Medicine; 🇹🇭 Chiang Mai, Thailand