Comparison of Antibiotic Dosing Before and After Implementation of an Electronic Order Set

Background: Hospitalized children frequently receive antibiotics, and clinical decision support can improve dosing accuracy. Paper ordersets with dosing guidance may improve the ordering accuracy but the impact of electronic ordersets on accuracy has not been evaluated. The objective of this study was to compare antibiotic dosing appropriateness before and after electronic orderset implementation.

Methods: This was a retrospective cohort study of patients less than 18 years of age who received IV cefepime, piperacillin-tazobactam, tobramycin, or gentamicin at 12 hospitals within a health system. Use of the ordersets and antibiotic dosing were evaluated in patients who received the specified antibiotics during the 6 months before and after electronic orderset implementation. Orders were excluded if initiated during the perioperative period, received via a verbal or telephone order, or administered as a one-time dose without a specified frequency. The primary outcome was comparison of appropriate antibiotic dosing before and after implementation.

Results: Seven hundred and forty seven antibiotic orders (n=747) were eligible for inclusion with 360 and 387 included in the before and after study periods, respectively. Gentamicin, piperacillin-tazobactam, cefepime, and tobramycin comprised 55.2%, 22.4%, 13.7%, and 8.8% of total orders, respectively. There was no difference in antibiotic order appropriateness in the before or after implementation periods (47.7% vs. 52.3%, p=0.415). Appropriateness did not differ when the electronic orderset was utilized vs. any other order format (90.5 % vs. 87.9 %, p=0.285). More orders were appropriate when the electronic orderset was utilized as compared to blank orders (90.5% vs. 82.8%, p=0.024).

Conclusions: No difference in antibiotic appropriateness was found based on during which study period the order occurred or the type of order format utilized. There was a significant difference in antibiotic appropriateness when comparing the use of a blank order form vs. the antibiotic electronic ordersets.