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Open AccessArticle

Implementation of an Extended-Infusion Piperacillin-Tazobactam Dosing Protocol: Unexpected Findings when Monitoring Safety and Compliance with Smart Pump Technology

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Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL 60515, USA
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Pharmacometrics Center of Excellence, Midwestern University, Downers Grove, IL 60515, USA
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Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL 60611, USA
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Department of Pharmacy, Loyola University Medical Center, Maywood, IL 60153, USA
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Department of Pharmacy, Jesse Brown Veteran Affairs Medical Center, Chicago, IL 60007, USA
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Department of Pharmacy, Rite Aid Pharmacy #5910, Benicia, CA 94510, USA
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The Institute for Innovations in Care and Quality, Illinois Hospital Association, Naperville, IL 60563, USA
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Feinberg School of Medicine, Medical Education, Northwestern University, Chicago, IL 60611, USA
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Antiviral Pharmacology Laboratory, University of Nebraska Medical Center (UNMC) Center for Drug Discovery, UNMC, Omaha, NE 68198, USA
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College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198, USA
*
Author to whom correspondence should be addressed.
Pharmacy 2019, 7(4), 169; https://doi.org/10.3390/pharmacy7040169
Received: 28 October 2019 / Revised: 18 November 2019 / Accepted: 8 December 2019 / Published: 11 December 2019
(This article belongs to the Special Issue Antimicrobial Stewardship across the Continuum of Care)
Compliance with recommended infusion rates was evaluated before, during, and after the implementation of extended-infusion (EI) piperacillin-tazobactam at an academic medical center. Software-controlled infusion-pump alert data were studied for piperacillin-tazobactam administrations before and after implementation of a four-hour EI protocol. Compliance was analyzed 16 weeks before (pre-EI), two weeks after (peri-EI), and an additional 16 weeks after (post-EI) protocol implementation. We defined potential harm as a programmed infusion rate exceeding the recommended rate, possible harm as a programmed infusion aborted by the user, and compliance as reversion to recommended rates. Potential and possible harm were standardized to 1000 patient days. Overall, 3110 alerts were identified during the period. Potential harm per 1000 patient days for pre-, peri-, and post-EI were 0, 6.12, and 1.05 (p < 0.001). Possible harm per 1000 patient days for the pre-, peri-, and post-EI were 0.33, 21.9, and 5.02 (p < 0.001). Compliance after an initial potential harm alert occurred more often post-EI (0.4 per 1000 patient days vs. 0 per 1000 patient days for pre- and peri-EI; p < 0.001), while alerts remaining in non-compliance were more prevalent if they initially occurred during the peri- and post-EI vs. pre-EI (6.1 and 0.6 per 1000 patient days vs. 0 per 1000 patient days; p < 0.001) period. Piperacillin-tazobactam infusions were administered faster than recommended during implementation (i.e., peri-EI) despite standardized orders. View Full-Text
Keywords: antimicrobial stewardship; extended-infusion; piperacillin-tazobactam; smart pump antimicrobial stewardship; extended-infusion; piperacillin-tazobactam; smart pump
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MDPI and ACS Style

J. Rhodes, N.; Lopez, J.; K. Pham, C.; Brake, H.; Fotis, M.; E. Harpe, S.; Avedissian, S.; H. Scheetz, M. Implementation of an Extended-Infusion Piperacillin-Tazobactam Dosing Protocol: Unexpected Findings when Monitoring Safety and Compliance with Smart Pump Technology. Pharmacy 2019, 7, 169.

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