Appropriateness of Intravenous Antibiotics Prescriptions at Hospital Discharge

Anti-Infectives Adverse Reaction Clinical Trial

Official title:

Quasi-experimental Study Comparing Intravenous Antibiotics Prescriptions at Hospital Discharge With and Without ID Consultation

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03173768
• Other study ID #: 3631
• Status: Completed
• Phase: N/A
• First received: April 3, 2017
• Last updated: June 1, 2017
• Start date: November 1, 2015
• Est. completion date: February 28, 2017

Study information

• Verified date: June 2017
• Source: Chiang Mai University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A quasi-experimental study was conducted among patients receiving care at the medicine units of the Maharaj Nakorn Chiang Mai Hospital to determine the appropriateness of intravenous antibiotics at hospital discharge with and without ID consultation.

Description:

The pre-intervention period was started from November 1, 2015 to April 30, 2016 (6-month period), in which the intravenous antibiotics at hospital discharge were prescribed by the primary care team. The post-intervention period was started from May 1, 2016 to February 28, 2017 (10-month period), in which the intravenous antibiotics at hospital discharge were reviewed and intervened by ID team.

The appropriateness of intravenous antibiotics was assessed separately by the ID fellow and ID specialist. If disagreement occurred, the feedback to the ID fellow was performed and the decision by ID specialist was used in the final analysis of appropriateness.

In post-intervention period, ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics

Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 173
• Est. completion date: February 28, 2017
• Est. primary completion date: February 28, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 15 Years and older

Eligibility

Inclusion Criteria:

All adult patients who met the following criteria were consecutively enrolled;

1. age= 15 years old and

2. had infections at any sites and received intravenous antibiotics.

Exclusion Criteria:

• They were evaluated by infectious diseases specialist for appropriate antibiotics during admission

Related Conditions & MeSH terms

• Anti-Infectives Adverse Reaction

Intervention

Procedure:
• ID specialist approval
Appropriateness of intravenous antibiotics ordered by the primary team was assessed by ID specialist. ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics. Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.

Locations

Country	Name	City	State
Thailand	Department of Medicine	Chiang Mai

Sponsors (1)

Lead Sponsor	Collaborator
Chiang Mai University

Country where clinical trial is conducted

Thailand, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The proportion of appropriateness of intravenous antibiotics prescriptions at hospital discharge between groups	To calculate the number of antibiotic prescriptions at hospital discharge over the total number of prescriptions, comparing between pre-and post-intervention period.	16 months
Secondary	The costs of antibiotics for the course of treatment	To compare the cost of antibiotics for the course of treatment between the 2 periods	16 months
Secondary	Clinical improvement at 1 week	To calculate the number of patients who had clinical improvement at 1 week over the total number of patients in each period, comparing between the 2 periods	1 week
Secondary	Readmission within 30 days, length of hospital stay	To calculate the number of patients who were readmitted within 30 days over the total number of patients in each period, comparing between the 2 periods	30 days
Secondary	Length of hospital stay	To calculate the length of hospital stays in days between 2 periods	60 days