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Audit of physicians' adherence to a preprinted order set for community-acquired pneumonia.

BACKGROUND
Community-acquired pneumonia is the seventh leading cause of death in Canada. Previous studies have shown reductions in both mortality rate and length of hospital stay with the use of guideline-concordant empiric therapy and standardized preprinted orders.


OBJECTIVES
The primary objective was to determine adherence to the preprinted order for community-acquired pneumonia at the University Hospital of Northern British Columbia (UHNBC). The study also had the following secondary objectives: to assess the appropriateness of prescribing of levofloxacin in relation to institutional recommendations; to determine adherence with recent guidelines from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) for the treatment of community-acquired pneumonia; and to determine all-cause mortality, duration of IV antibiotic therapy, and length of stay for the various regimens reviewed.


METHODS
A retrospective observational chart review was conducted of patients with community-acquired pneumonia who were admitted between November 2007 and February 2008. Exclusion criteria were designed to eliminate patients who did not have this condition. Descriptive statistics were used to assess adherence with the preprinted order. Secondary outcomes were analyzed with the Pearson χ(2) test, t tests, and analysis of variance.


RESULTS
In total, the charts for 113 patients were reviewed, and 58 patients were included in the study. The preprinted order for community-acquired pneumonia was used for 25 (43%) of the 58 patients; however, for only 4 (7%) of these admissions were all sections of the preprinted order used correctly. No statistically significant differences in length of stay were found for any of the antibiotic combinations assessed. However, the proportion of patients treated according to the IDSA-ATS guidelines was significantly greater when the preprinted order was used (p = 0.012). In addition, use of the preprinted order encouraged assessment of the patient's pneumococcal vaccination status (9 [25%] of 25 patients versus 3 [9%] of 33 patients) and utilization of the pneumonia severity index (13 [52%] of 25 patients versus 0 [0%] of 33 patients).


CONCLUSION
The preprinted order for community-acquired pneumonia at UHNBC was not being utilized to its fullest. However, when it was used, it increased guideline-concordant empiric therapy and encouraged assessment of patients' pneumococcal vaccination status and pneumonia severity index.