RESUMO
Background: Due to the need of patients to the intensive care unit [ICU] for receiving medical and nursing services, these services should be provided in a timely manner. This study aimed to develop the clinical guidelines for admission criteria of intensive care unit
Materials and Methods: This study was observational type study was conducted for nine months in 2015 based on a three-step process of adoption of clinical guidelines including planning, adoption and finalization. After conducting systematic searches, the quality of retrieved clinical guidelines was evaluated by experts from policy makers in the admission of patients in the ICU. Finally, the ultimate version of the guideline was developed after reviewing and organizing expert panel sessions
Results: The criteria for accepting patients were presented in form of seven clauses based on the neurological status, cardiovascular status, respiratory status, water and electrolyte disorders, gastrointestinal disturbances, endocrine disorders, surgery and postoperative care
Conclusion: One of the most important factors of creating demand inducing to the patients is the lack of clinical guidelines. It is recommended that departmental doctors should apply the mentioned clinical guidelines in order to make the resources of the intensive care unit more effective
RESUMO
Background: Judicious use of antibiotics is essential considering the growth of antimicrobial resistance and escalating costs in health care
Ceftriaxone is a third-generation cephalosporin used widely for the treatment of various infections in outpatient and in-patient. The purpose of this study was to evaluate the ceftriaxone utilization before and after implementation of guidelines and physicians education
Methods: A descriptive cross-sectional, before-after intervention study was performed in 6 wards of a teaching hospital in Tehran, Iran
The study was conducted in three phases: pre-guideline, educational interventions and post guideline implementation
The pre intervention phase included chart analysis of current ceftriaxone use in 200 consecutive patients from the representative wards included in the study
The educational interventions included preparation and distribution of ceftriaxone guidelines as pamphlets among physicians working in the studied wards
Also the clinical pharmacist returned to each ward and trained physicians regarding the correct use of ceftriaxone. In the post intervention phase immediately after the instruction, and in the follow up phase, one month later, a prospective analysis of ceftriaxone utilization was performed by chart review of 200 patients to detect changes in ceftriaxone utilization pattern
Results: Four hundred cases were evaluated during study [200 before and 200 after physician's education]
The correct indication of ceftriaxone was 93% and 96% before and after the educational interventions respectively. Analysis showed that correct indication of ceftriaxone did not change significantly before and after education [P= 0.188]
Regarding to proper administration [dose, interval and duration] ceftriaxone utilization significantly changed after education [P< 0.001]
Conclusion: Adoption of the guidelines with associated training resulted in significant improvement in ceftriaxone administration pattern in the hospitals