History Antibiotics and proton pump inhibitors (PPIs) are connected with infection (CDI). and PPIs during each stage. Outcomes This alert resulted in a significant decrease in the co-administration of antibiotics and PPIs altered for month and secular developments expressed as times of therapy per 100 affected person times (4.99 vs. 3.14 <0.001). No modification was seen in adjusted monthly CDI rates per 100 patient care days between the baseline and alert cohorts (0.12 vs. 0.12 infection Prospective audit and feedback Background Hospitalization represents an opportunity to assess medication appropriateness. Proton pump inhibitors (PPIs) are frequently inappropriately used and represent an ideal target for re-evaluation [1 2 PPIs increase the risk of infection (CDI) including both incident episodes as well as recurrences by approximately 60?% [3 4 This elevated risk exists irrespective of whether the infection was acquired in a community or hospital setting [4 5 Antibiotics also increase the risk of nosocomial CDI particularly when prescribed concurrently with a PPI [6-9]. Accordingly interventions targeting a reduction in the co-administration of PPIs and antibiotics may be beneficial. Automated alerts activated at the time of computer order entry (CPOE) have been used to reduce iMAC2 medical errors through warnings of impending drug-drug interactions and unrecognized drug allergies. Similar interventions have successfully altered PPI prescribing patterns in the hospital setting and changed antibiotic prescribing patterns [10 11 A similar automated iMAC2 strategy may reduce concurrent PPI and antibiotic use but this has not yet been tested. Extending the purview of antibiotic stewardship programs (ASP) which are successful in lowering antibiotic use in the acute care setting to identify medications with the potential to increase the harms of antibiotics is another potential intervention to limit co-administration [12]. We evaluated the impact of the real-time automated pc physician order admittance (CPOE) alert Rabbit polyclonal to PEX14. accompanied by an ASP-initiated potential audit and responses (PAF) technique on prices of co-administration of PPI’s and antibiotics in a big teaching medical center in Ontario Canada. Strategies Study style We prospectively evaluated consecutive patients admitted to two General Internal Medicine wards from October 1 2010 until March 31 2013 at a 490-bed teaching hospital in Toronto Ontario Canada. The baseline observation interval occurred from October 1 2010 until September 30 2011 The first phase from October 1 2011 until March 31 2012 involved the implementation of a CPOE alert that was brought on when either a PPI or an antibiotic was ordered in the presence of the other. This alert highlighted the association of concurrent PPI’s and antibiotics with the increased risk of subsequent CDI. Embedded within the alert was an educational tool that assisted with a risk-benefit analysis of whether to stop a PPI which for example should be continued in the setting of a recent upper gastrointestinal bleed. The second phase consisted of the introduction of an ASP-initiated PAF strategy which occurred from April 1 2012 until March 31 2013 PAF was brought on from Monday to Friday when an inpatient was prescribed a systemic antimicrobial agent. The aim of the ASP was to provide recommendations regarding the appropriateness of antimicrobial therapy as well as to note the concomitant use of a PPI. Ethics approval was granted from Toronto East General Hospital’s Research Ethics Board. Outcome measures Inpatient orders of antibiotics and PPIs were obtained from the computer order entry system (PowerChart Cerner Canada Markham Canada) and reported as days of therapy (DOT) for each individual medication per 100 inpatient days. One iMAC2 DOT represents the administration of a single medication on a given day irrespective of dosing frequency or strength. Hospital-acquired CDI was confirmed using the iMAC2 Ontario Ministry of Health and Long Term Care case definition with toxin recognition by enzyme immunoassay or polymerase string reaction and iMAC2 shown as an interest rate over 100 inpatient times [13]. Just loose stool specimens were repeat and prepared testing of duplicate specimens within a week had not been permitted. The primary result was co-administration of PPI’s and.