Oral quinolones in hospitalized patients: an evaluation of a computerized decision support intervention

Abstract

Objective: To determine whether a computerized decision support system could increase the proportion of oral quinolone antibiotic orders placed for hospitalized patients.

Design: Prospective, interrupted time-series analysis.

Setting: University hospital in the south-eastern United States.

Subjects: Inpatient quinolone orders placed from 1 February 2001 to 31 January 2003.

Intervention: A web-based intervention was deployed as part of an existing order entry system at a university hospital on 5 February 2002. Based on an automated query of active medication and diet orders, some users ordering intravenous quinolones were presented with a suggestion to consider choosing an oral formulation.

Main outcome measure: The proportion of inpatient quinolone orders placed for oral formulations before and after deployment of the intervention.

Results: There were a total of 15 194 quinolone orders during the study period, of which 8962 (59%) were for oral forms. Orders for oral quinolones increased from 4202 (56%) before the intervention to 4760 (62%) after, without a change in total orders. In the time-series analysis, there was an overall 5.6% increase (95% CI 2.8-8.4%; P < 0.001) in weekly oral quinolone orders due to the intervention, with the greatest effect on nonintensive care medical units.

Conclusions: A web-based intervention was able to increase oral quinolone orders in hospitalized patients. This is one of the first studies to demonstrate a significant effect of a computerized intervention on dosing route within an antibiotic class. This model could be applied to other antibiotics or other drug classes with good oral bioavailability.