Abstract | BACKGROUND:
Gentamicin is an aminoglycoside antibiotic that is highly effective in treating Gram-negative infections, but inappropriate use leads to toxicity. In 2010, the Australian Therapeutic Guidelines ( Antibiotic) were revised to recommend the use of computerised methods to individualise dosing of gentamicin and optimise therapy, rather than traditional nomogram approaches. AIM: To determine whether gentamicin prescribing was compliant with the Australian Therapeutic Guidelines, version 14 (2010) in a setting where computerised dose recommendation resources and computerised decision support were available, and to determine why the resources were effective or ineffective in achieving compliance to guidelines. METHODS: During phase 1, a retrospective audit of gentamicin prescribing from 1 January 2012 to 31 December 2012 (n = 826) at a 320-bed teaching hospital in Sydney was undertaken. In phase 2, 12 doctors from specialties with high-volume prescribing of gentamicin were interviewed. RESULTS: Intravenous gentamicin was used in 545 cases, 81% of which were for short-term therapy (≤48 h). Doctors feared inducing toxicity in patients, but limited the dose rather than altering the dosing interval according to renal function. Of the 'continued' dosing cases, 55% went unmonitored and the computerised dose recommendation service was rarely used. Doctors were unaware of its availability despite electronic alerts accompanying prescriptions of gentamicin. CONCLUSIONS: In comparison with the national guidelines, there was significant under-dosing and monitoring practices were haphazard. Computerised electronic alerts were ineffective in informing users. To improve prescribing practices, we recommend exploring alternative computerised decision support approaches (e.g. pre-written orders) and more pervasive and persuasive implementation strategies.
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Authors | N Diasinos, M Baysari, S Kumar, R O Day |
Journal | Internal medicine journal
(Intern Med J)
Vol. 45
Issue 1
Pg. 55-62
(Jan 2015)
ISSN: 1445-5994 [Electronic] Australia |
PMID | 25371347
(Publication Type: Clinical Trial, Phase I, Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © 2014 Royal Australasian College of Physicians. |
Chemical References |
- Anti-Bacterial Agents
- Gentamicins
|
Topics |
- Aged
- Anti-Bacterial Agents
(administration & dosage)
- Decision Support Systems, Clinical
- Dose-Response Relationship, Drug
- Drug Monitoring
(methods)
- Drug Prescriptions
(standards)
- Female
- Follow-Up Studies
- Gentamicins
(administration & dosage)
- Gram-Negative Bacterial Infections
(drug therapy, epidemiology)
- Guideline Adherence
- Hospitals, Teaching
(statistics & numerical data)
- Humans
- Male
- Middle Aged
- Morbidity
(trends)
- New South Wales
(epidemiology)
- Patient Compliance
- Practice Patterns, Physicians'
- Retrospective Studies
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