目的:本研究评估了实施机构指南后小儿发热性中性粒细胞减少症(FN)患者抗菌药物选择适当性的差异,专门的儿科急诊医学(EM)药剂师,和一个电子订单集。
方法:这是一项回顾性队列研究,包括年龄小于18岁的有中性粒细胞减少症风险的发热患者,正如我们的机构算法所定义的那样。通过搜索2018年2月至2022年1月期间就诊于急诊科(ED)的具有国际疾病分类的患者,对图表进行了评估。第十次修订(ICD-10)代码适用于有FN风险的患者。三个独立的组间比较,during,干预后。历史对照组(第1组),专职EM药剂师和机构指南队列(第2组),和专职的EM药剂师,机构指南,和电子订单集队列(第3组)进行比较。次要结局包括从ED登记到第一剂经验性抗菌药物给药的时间,天数到退热,儿科重症监护病房住院时间,和住院时间。
结果:回顾了78张图表。其中包括(n=38),在第1组,第2组和第3组之间,抗菌药物的适当使用分别从71%增加到92%增加到100%(P=0.1534).此外,本研究中的干预措施导致从注册到首次使用抗生素的中位时间从142分钟总体减少到72分钟(P=0.1370).
结论:这项研究证明了儿科EM药师以及机构指南和电子医嘱集对儿科FN患者适当选择抗菌药物的积极影响。机构应考虑多管齐下的方法,以改善ED中适当的经验性抗菌药物的选择和管理时间。
OBJECTIVE: This study evaluated the difference in appropriateness of antimicrobial selection in pediatric patients with febrile neutropenia (FN) after implementation of an institutional
guideline, a dedicated pediatric emergency medicine (EM) pharmacist, and an electronic order set.
METHODS: This was a retrospective cohort study that included febrile patients aged younger than 18 years who were at risk of neutropenia, as defined by our institutional algorithm. Charts were evaluated for inclusion by searching for patients who presented to the emergency department (ED) between February 2018 and January 2022 who had International Classification of Diseases, Tenth Revision (ICD-10) codes for patients at risk of FN. Three independent groups were compared before, during, and after interventions. A historical control group (group 1), postdedicated EM pharmacist and institutional
guideline cohort (group 2), and postdedicated EM pharmacist, institutional
guideline, and electronic order set cohort (group 3) were compared. Secondary outcomes included time from registration in the ED to administration of the first dose of empiric antimicrobials, days to defervescence, pediatric intensive care unit length of stay, and hospital length of stay.
RESULTS: Seventy-eight charts were reviewed for inclusion. Among those included (n = 38), there was an increase in appropriate use of antimicrobials from 71% to 92% to 100% ( P = 0.1534) between group 1, group 2, and group 3, respectively. In addition, the interventions in this study lead to an overall decrease in the median time from registration to first dose of antibiotics from 142 minutes to 72 minutes ( P = 0.1370).
CONCLUSIONS: This study demonstrated the positive impact a pediatric EM pharmacist along with an institutional
guideline and an electronic order set have on appropriate antimicrobial selection in pediatric FN patients. Institutions should consider multipronged approaches to improve the selection and time to administration of appropriate empiric antimicrobials in the ED.