Improving the selection of recommended prophylactic antibiotics using an electronic medical record

OBJECTIVE: To estimate the effect of reference text in an electronic medical record (EMR) on the recommended use of preoperative antibiotics for cesarean deliveries. METHODS: A retrospective cohort study of all cesarean deliveries at Stony Brook Hospital between May 2009 and June 2011, was performed. Reference text was added to the EMR in May 2010. The cesarean deliveries performed before (group 1) and after (group 2) the addition of the reference text were compared for the type and dose of antibiotic ordered preoperatively, as well as the patientÊs body mass index (BMI), drug allergies, and diagnosis of chorioamnionitis. Those with chorioamnionitis were excluded. The χ and t tests were performed to study differences between the groups. RESULTS: Of the 2,273 deliveries identified, 172 were excluded for chorioamnionitis or incomplete medical records. The women in group 1 had a higher BMI (33.3±7.3 kg/m) compared with the women in group 2 (32.6±6.3 kg/m; P=.005). Otherwise, there were no differences between the groups regarding maternal weight, penicillin allergy, or other antibiotics. There was a significant increase in the number of patients receiving the adequate (92.6% compared with 85.7%; P<.005) and recommended (58.1% compared with 43.4%; P<.005) antibiotics in group 2 when compared with group 1. CONCLUSION: Reference text included within the EMR that prompts physicians to select the recommended antibiotics significantly improves preoperative antibiotic use.