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The devil’s in the defaults: An interrupted time-series analysis of the impact of default duration elimination on exposure to fluoroquinolone therapy

Published online by Cambridge University Press:  13 February 2024

Rebekah H. Wrenn Open the ORCID record for Rebekah H. Wrenn [Opens in a new window] ,
Cara N. Slaton Open the ORCID record for Cara N. Slaton [Opens in a new window] ,
Tony Diez Sr ,
Nicholas A. Turner Open the ORCID record for Nicholas A. Turner [Opens in a new window] ,
Michael E. Yarrington Open the ORCID record for Michael E. Yarrington [Opens in a new window] ,
Deverick J. Anderson Open the ORCID record for Deverick J. Anderson [Opens in a new window]  and
Rebekah W. Moehring Open the ORCID record for Rebekah W. Moehring [Opens in a new window]
Rebekah H. Wrenn*
Affiliation:
Duke University Medical Center, Durham, North Carolina Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
Cara N. Slaton
Affiliation:
Orlando Health Orlando Regional Medical Center, Orlando, Florida
Tony Diez Sr
Affiliation:
Duke University Medical Center, Durham, North Carolina
Nicholas A. Turner
Affiliation:
Duke University Medical Center, Durham, North Carolina
Michael E. Yarrington
Affiliation:
Duke University Medical Center, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Duke University Medical Center, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Duke University Medical Center, Durham, North Carolina Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
*
Corresponding author: Rebekah H. Wrenn; Email: rebekah.wrenn@duke.edu
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Abstract

Objective:

To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy.

Design:

Interrupted time-series analysis.

Setting:

The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics.

Patients:

Adults prescribed a fluoroquinolone with a duration <31 days.

Interventions:

Removal of standard 10-day fluoroquinolone default duration and addition of literature-based duration guidance in the order entry on December 19, 2017. The study period included data for 12 months before and after the intervention.

Results:

The study included 35,609 fluoroquinolone e-scripts from the preintervention period and 31,303 fluoroquinolone e-scripts from the postintervention period, accounting for 520,388 cumulative fluoroquinolone DOT. Mean durations before and after the intervention were 7.8 (SD, 4.3) and 7.7 (SD, 4.5), a nonsignificant change. E-scripts with a 10-day duration decreased prior to and after the default removal. The inpatient setting showed a significant 8% drop in 10-day e-scripts after default removal and a reduced median duration by 1 day; 10-day scripts declined nonsignificantly in ED and ambulatory settings. In the ambulatory settings, both 7- and 14-day e-script durations increased after default removal.

Conclusion:

Removal of default 10-day antibiotic durations did not affect overall mean duration but did shift patterns in prescribing, depending on practice setting. Stewardship interventions must be studied in the context of practice setting. Ambulatory stewardship efforts separate from inpatient programs are needed because interventions cannot be assumed to have similar effects.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 6 , June 2024 , pp. 733 - 739
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. The preliminary results of this study were presented at IDWeek 2018 on October 3–7, 2018, in San Francisco, California.

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