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Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital

(2010) PHARMACY WORLD & SCIENCE. 32(3). p.404-410
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Organization
Abstract
Objective: This study measured the impact of three interventions for physicians, in order to implement guidelines for sequential therapy (intravenous to oral conversion) with fluoroquinolones. Setting A Belgian university hospital with 1,065 beds. Method: The first intervention consisted of the hospital-wide publication of guidelines in the local drug letter towards all prescribers. The consumption of fluoroquinolones was measured by means of an interrupted time-series (ITS) analysis 21 months before (period A) and 24 months after publication (period B). The second intervention was an educational interactive session, by infectious disease specialists, to the medical staff of orthopaedics and endocrinology. The third intervention comprised a proactive conversion programme on the abdominal surgery, gastro-enterology and plastic surgery wards, where pharmacists attached a pre-printed note with a suggestion to switch to an oral treatment every time a patient met the criteria for switching. The second and third intervention took place 6 months after the first intervention. Fluoroquinolone treatments were evaluated during a 2 month period before (group 1) and after the introduction of the second (group 2) and third (group 3) intervention. Main outcome measure: The monthly ratio of intravenous versus total fluoroquinolone consumption (daily defined doses per 1,000 bed days) was measured to assess the impact of the first intervention. The impact of the second and third intervention was measured in relation to the number of days that intravenous therapy continued beyond the day that the patient fulfilled the criteria for sequential therapy and the antibiotic cost. Results: The ITS demonstrated a reduction of 3.3% in the ratio of intravenous versus total consumption after the publication of the guidelines (P = 0.011). In group 1, patients were treated intravenously for 4.1 days longer than necessary. This parameter decreased in group 2 to 3.5 days and in group 3 to 1.0 day (P = 0.006). The mean additional cost for longer intravenous treatment decreased from 188.0 epsilon in group 1, to 103.0 epsilon in group 2 and 44.0 epsilon in group 3 (P = 0.037). Conclusion This study demonstrated that active implementation of guidelines is necessary. A proactive conversion programme by a pharmacist resulted in a reduction in the duration of the intravenous treatment, and the treatment cost.
Keywords
PNEUMONIA, QUINOLONES, ROUTE, INTERVENTION, PROGRAM, CONVERSION, EARLY SWITCH, ANTIMICROBIAL THERAPY, ORAL ANTIBIOTICS, INTERRUPTED TIME-SERIES, Practice guidelines, Fluoroquinolones, Drug administration, Clinical pharmacy, Belgium, Prescribing, Antibiotics

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Chicago
Buyle, Franky, Dirk Vogelaers, Renaat Peleman, GEORGES VAN MAELE, and Hugo Robays. 2010. “Implementation of Guidelines for Sequential Therapy with Fluoroquinolones in a Belgian Hospital.” Pharmacy World & Science 32 (3): 404–410.
APA
Buyle, F., Vogelaers, D., Peleman, R., VAN MAELE, G., & Robays, H. (2010). Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital. PHARMACY WORLD & SCIENCE, 32(3), 404–410.
Vancouver
1.
Buyle F, Vogelaers D, Peleman R, VAN MAELE G, Robays H. Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital. PHARMACY WORLD & SCIENCE. 2010;32(3):404–10.
MLA
Buyle, Franky, Dirk Vogelaers, Renaat Peleman, et al. “Implementation of Guidelines for Sequential Therapy with Fluoroquinolones in a Belgian Hospital.” PHARMACY WORLD & SCIENCE 32.3 (2010): 404–410. Print.
@article{1193501,
  abstract     = {Objective: This study measured the impact of three interventions for physicians, in order to implement guidelines for sequential therapy (intravenous to oral conversion) with fluoroquinolones. Setting A Belgian university hospital with 1,065 beds.
Method: The first intervention consisted of the hospital-wide publication of guidelines in the local drug letter towards all prescribers. The consumption of fluoroquinolones was measured by means of an interrupted time-series (ITS) analysis 21 months before (period A) and 24 months after publication (period B). The second intervention was an educational interactive session, by infectious disease specialists, to the medical staff of orthopaedics and endocrinology. The third intervention comprised a proactive conversion programme on the abdominal surgery, gastro-enterology and plastic surgery wards, where pharmacists attached a pre-printed note with a suggestion to switch to an oral treatment every time a patient met the criteria for switching. The second and third intervention took place 6 months after the first intervention. Fluoroquinolone treatments were evaluated during a 2 month period before (group 1) and after the introduction of the second (group 2) and third (group 3) intervention.
Main outcome measure: The monthly ratio of intravenous versus total fluoroquinolone consumption (daily defined doses per 1,000 bed days) was measured to assess the impact of the first intervention. The impact of the second and third intervention was measured in relation to the number of days that intravenous therapy continued beyond the day that the patient fulfilled the criteria for sequential therapy and the antibiotic cost.
Results: The ITS demonstrated a reduction of 3.3\% in the ratio of intravenous versus total consumption after the publication of the guidelines (P = 0.011). In group 1, patients were treated intravenously for 4.1 days longer than necessary. This parameter decreased in group 2 to 3.5 days and in group 3 to 1.0 day (P = 0.006). The mean additional cost for longer intravenous treatment decreased from 188.0 epsilon in group 1, to 103.0 epsilon in group 2 and 44.0 epsilon in group 3 (P = 0.037).
Conclusion This study demonstrated that active implementation of guidelines is necessary. A proactive conversion programme by a pharmacist resulted in a reduction in the duration of the intravenous treatment, and the treatment cost.},
  author       = {Buyle, Franky and Vogelaers, Dirk and Peleman, Renaat and VAN MAELE, GEORGES and Robays, Hugo},
  issn         = {0928-1231},
  journal      = {PHARMACY WORLD \& SCIENCE},
  keyword      = {PNEUMONIA,QUINOLONES,ROUTE,INTERVENTION,PROGRAM,CONVERSION,EARLY SWITCH,ANTIMICROBIAL THERAPY,ORAL ANTIBIOTICS,INTERRUPTED TIME-SERIES,Practice guidelines,Fluoroquinolones,Drug administration,Clinical pharmacy,Belgium,Prescribing,Antibiotics},
  language     = {eng},
  number       = {3},
  pages        = {404--410},
  title        = {Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital},
  url          = {http://dx.doi.org/10.1007/s11096-010-9384-y},
  volume       = {32},
  year         = {2010},
}

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