Design, implementation, and use of a new antimicrobial order form: a descriptive report

OBJECTIVE: To describe the development, implementation, and use of an antimicrobial order form. The article provides the design of the form and the rationale for including key aspects, and a report of the authors' experiences with the form over a three-year period. An analysis of compliance with the form and its impact on selected prescribing practices is also presented. DESIGN: Three thousand five hundred antimicrobial orders in four discrete sets over a three-year period were analyzed to assess compliance and characterize prescribing patterns with respect to duration of therapy and dosing frequency. SETTING: The setting of the study was a 300-bed, university-affiliated, tertiary-care, teaching hospital. MAIN OUTCOME MEASURES: Analysis of the forms was organized into the following sections: (1) compliance with use of the form, (2) duration of therapy, and (3) impact on antimicrobial dosing intervals. RESULTS: Use of the form was essentially 100 percent. Seventy-eight percent of the forms had all required data elements completed in the period following implementation; this fell to 67 percent at the end of three years. Duration of surgical prophylaxis went beyond the recommended 24 hours in 10 percent of all cases in period 1, and in 18, 8, and 4 percent in periods 2, 3, and 4, respectively. Declines in inappropriate dosing frequency were seen with cefazolin (from 14 to 2.3 percent), ceftriaxone (from 23 to 4 percent), cefuroxime (from 21 to 0 percent), and clindamycin (from 43 to 7 percent). CONCLUSIONS: Our experience with implementation and use of the form was very positive. Significant difficulties with compliance were not encountered. Benefits of the form included reductions in the duration of surgical prophylaxis and in the frequency of inappropriate dosing intervals.