Original Research

Impact of a restrictive antimicrobial policy on the process and timing of antimicrobial administration†

  1. Bradford D. Winters MD, PhD1,
  2. David R. Thiemann MD2,
  3. Daniel J. Brotman MD, FHM, FACP2,‡,*

Article first published online: 8 JAN 2010

DOI: 10.1002/jhm.561

Issue

Journal of Hospital Medicine

Journal of Hospital Medicine

Volume 5, Issue 1, pages E41–E45, January 2010

Additional Information

How to Cite

Winters, B. D., Thiemann, D. R. and Brotman, D. J. (2010), Impact of a restrictive antimicrobial policy on the process and timing of antimicrobial administration. J. Hosp. Med., 5: E41–E45. doi: 10.1002/jhm.561

Author Information

  1. 1

    Department of Anesthesiology and Critical Care Johns Hopkins University, Baltimore, Maryland

  2. 2

    Department of Medicine, Johns Hopkins University, Baltimore, Maryland

  1. ‡

    Telephone: 4109559080; Fax: 410-502-0923

*Hospitalist Program, Johns Hopkins Hospital, 600 North Wolfe St./Park 307, Baltimore, MD 21287

  1. †

    Disclosure: Nothing to report.

  2. ‡

    Telephone: 4109559080; Fax: 410-502-0923

Publication History

  1. Issue published online: 8 JAN 2010
  2. Article first published online: 8 JAN 2010
  3. Manuscript Accepted: 20 MAY 2009
  4. Manuscript Revised: 12 MAY 2009
  5. Manuscript Received: 19 DEC 2008

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Keywords:

  • antimicrobial;
  • infection control;
  • process of care

Abstract

BACKGROUND:

In-hospital antimicrobial approval policies are designed to curb the indiscriminant use of antimicrobials. These policies usually require written forms and/or direct requests to an Infectious Disease specialist (or surrogate) prior to release of the antimicrobial. We hypothesized that the approval processes at our institution results in delayed antimicrobial administration.

METHODS:

We performed a retrospective cohort study examining the time from order to administration for 25 different antimicrobials ordered “stat.” Antimicrobials were classified as restricted (required approval) or unrestricted. We compared these 2 classes to each other both during the daytime (8 AM to 10 PM), when approval is required for restricted antimicrobials, and at night when the first dose of all antimicrobials is exempted. We defined a delay in administration when the medication was given >1 hour from time of order. We separately examined delays of >2 hours.

RESULTS:

A higher percentage of >1-hour delays occurred when the antimicrobial was restricted (odds ratio [OR] = 1.49; 95% confidence interval [CI] = 1.23-1.82). Similar results were seen for >2-hour delays (OR = 1.78; 95% CI = 1.39-2.21). During the exempt-from-restriction time period (10 PM to 8 AM), there was no difference between these 2 classes of antimicrobials. Results were unchanged by adjustment for service (medicine vs. surgery vs. other), patient characteristics (age, sex, race), or by weekday vs. weekend.

CONCLUSIONS:

Statistically significant delays in stat antimicrobial administration occur in our institution when antimicrobials require preapproval. These findings illustrate the importance of considering clinical efficiency when restrictions are put in place for time-sensitive therapies such as antimicrobials. Journal of Hospital Medicine 2010;5:E41–E45. © 2010 Society of Hospital Medicine.

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