Skip to content

STANDARDIZED ORDER SETS FOR ANTIBIOTICS IN THE EMERGENCY ROOM

Pdf

PDF Icon

European Statement

Patient Safety and Quality Assurance

Author(s)

Natalia Toledo Noda, Víctor Quesada Marqués, Héctor Alonso Ramos, Moisés Pérez León, María Victoria Morales León

Why was it done?

It has been observed that emergency physicians tend to prescribe higher doses of antibiotics even though a lower dose is enough for the most common pathologies. This implied a decrease in safety, a probable increase in bacterial resistance as well as an increase in cost.

What was done?

The dose of antibiotics that appeared by default in the pharmacological prescription program were adjusted with the aim of reducing overdose.

How was it done?

The most common pathologies in the emergency room were taken into account and the pharmacist, in agreement with the emergency physicians and following the Antimicrobial Stewardship Program, programmed those doses by default in the order set. For example, 1g of ceftriaxone once a day instead of 2g is enough for urinary tract infections and community-acquired pneumonia and 1 or 2 doses of oral phosphomycin are enough to treat non-complicated urinary tract infection. Regarding weight-adjusted antibiotics (for example amikacin), it was proposed that the dose corresponding to 65kg should appear by default in the program, which is the average weight that our patients in the emergency room usually have. These measures were intended to make the prescription as safe as possible.

What has been achieved?

The measures adopted by the Pharmacy Service achieved a drastic reduction in the overdose of antibiotics. The potential for medication errors was decreased and, therefore, patient safety improved. Unnecessary calls to prescribers for clarifications and questions about orders were also avoided. In economic terms, it has been possible to save almost 40% of the cost of treatment per patient. However, the aim of this measure was never resourcing optimization since most antibiotics used in the emergency room do not have a high cost.

What next?

In addition to the treatment protocols according to pathologies that are usually predefined in order sets, these actions carried out (not just in antibiotics) can be useful in emergency departments and for medical professionals who are not as used to prescribing medication. The use of well-designed order sets requires vigilance and a team approach because if they are not carefully designed, reviewed, and maintained to reflect evidence-based care, they may contribute to errors.

×

EAHP Forum

All the EAHP team is working on providing a Forum that can help connect all the members in Conversations and Groups to talk about important matters for the European Hospital Pharmacist.

The Forum will be accessible for all the EAHP members, you don’t have to create a new account to browse and participate.

Conversations and groups

The Conversations will be moderated by our team to provide documents and relevant topics for the community.

The Groups will connect all members that share a category. Members who work on the same assocation, on the same hospital, that have the same role, etc.

Stay tuned for the realase of the forum. Soon on EAHP.