Brian L Erstad

Abstract:

Purpose: To examine the rate of compliance with National Surgical Infection Prevention Project performance measures and compliance with American Society of Health-System Pharmacists guidelines for procedures not covered by these measures and to evaluate noncompliance for explanatory factors. Methods: A retrospective review of all patients receiving prophylactic antibiotics for Class I (clean) or Class II (clean-contaminated) surgical procedures. Information collected included antibiotic ordered, antibiotic given, dose of antibiotic, time of administration, time of incision, time of closure, duration of procedure, need for re-dosing during the procedure, documentation of re-dosing administered, and antibiotic discontinuation. Results: Choice of antibiotic for prophylaxis was appropriate in 99% of the 568 procedures. Antibiotic was administered too early in 94 of 527 (17.8%) patients. Prophylactic antibiotics were inappropriately continued for more than 24 hours in 43 of 216 (20%) patients undergoing noncardiothoracic procedures and for more than 48 hours in 4 of 10 (40%) in patients undergoing cardiothoracic surgery. Conclusion: Although improvements in key performance measures related to prophylactic antibiotic agent selection, timing of administration, and discontinuation have been made compared to data collected in a larger multicenter study conducted at the beginning of this century, there remains considerable room for improvement. © 2006 Sage Publications.

Abstract:

Background: No surveys of stress ulcer prophylaxis prescribing in the USA have been conducted since 1995. Since that time, the most comprehensive meta-analysis and largest randomized study to date concerning stress ulcer prophylaxis have been published. Results: Three hundred sixty-eight surveys were sent to all members of the Section of Pharmacy and Pharmacology of the Society of Critical Care Medicine. One hundred fifty-three (42%) surveys were returned. Representatives from 86% of institutions stated that medications for stress ulcer prophylaxis are used in a majority (>90%) of patients admitted to the intensive care unit (ICU). Twenty-two per cent of institutions have recommendations for both ICU and non-ICU settings. Fifty- eight per cent of institutions stated that there was one preferred medication for stress ulcer prophylaxis, and in 77% of these histamine-2-antagonists were the most popular. Conclusions: There are wide variations in prescribing practices for stress ulcer prophylaxis. Institutions should consult published literature and use pre-existing guidelines as templates for developing their own guidelines.

PMID: 7503604;Abstract:

Background: Crystalloids, nonprotein colloids (NPCs), and albumin are used for many indications. The use of the least costly agent in situations where these products are clinically interchangeable can reduce health care costs. Objectives: To characterize the prescribing of albumin and NPC. To evaluate the appropriateness and cost implications of their use. Methods: An observational study conducted in 15 academic health centers from April 11 through May 6, 1994, to assess the appropriateness of albumin and NPC use, based on 'model' consensus-derived indication guidelines. Results: A total of 969 case report forms were evaluated. Albumin and NPCs were administered in 83% and 17% of the cases, respectively. Albumin and NPCs were administered mostly in the intensive care (50%) or operating room (31%) settings. The most common prescribers of these products were surgeons (45%) and anesthesiologists (20%). In 87% of cases, albumin or NPC was administered to reach a defined end point (eg, to achieve a target physiological state or to resolve a pathophysiological condition). Only one albumin recipient experienced an adverse event; no adverse events were noted with NPC administration. Approximately $203 000 was spent on albumin and NPC therapy for the 969 cases; $49 702 (24%) was spent on appropriate administrations, $124 939 (62%) on inappropriate administrations, and $28 014 (14%) on unevaluated indications. Conclusions: Evaluated against model guidelines, most of the albumin and NPC use in the study was found to be inappropriate. The need for institutions to define and implement guidelines that focus on the cost-efficient use of these agents is recommended in an increasingly cost-conscious health care environment.