Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial.

BACKGROUND Vancomycin-resistant enterococci represent an increasingly important cause of nosocomial infections. Minimizing vancomycin use represents a key strategy in preventing the spread of these infections. OBJECTIVE To determine whether a structured ordering intervention using computerized physician order entry that requires use of a guideline could reduce intravenous vancomycin use. DESIGN Randomized controlled trial assessing frequency and duration of vancomycin therapy by physicians. PARTICIPANTS AND SETTING Three hundred ninety-six physicians and 1,798 patients in a tertiary-care teaching hospital. INTERVENTION Computer screen displaying, at the time of physician order entry, an adaptation of the Centers for Disease Control and Prevention guidelines for appropriate vancomycin use. MAIN OUTCOME MEASURES The frequency of initiation and renewal of vancomycin therapy as well the duration of therapy prescribed on a per prescriber basis. RESULTS Compared with the control group, intervention physicians wrote 32 percent fewer orders (11.3 versus 16.7 orders per physician; P = 0.04) and had 28 percent fewer patients for whom they either initiated or renewed an order for vancomycin (7.4 versus 10.3 orders per physician; P = 0.02). In addition, the duration of vancomycin therapy attributable to physicians in the intervention group was 36 percent lower than the duration of therapy prescribed by control physicians (26.5 versus 41.2 days; P = 0.05). Analysis of pharmacy data confirmed a decrease in the overall hospital use of intravenous vancomycin during the study period. CONCLUSION Implementation of a computerized guideline using physician order entry decreased vancomycin use. Computerized guidelines represent a promising tool for changing prescribing practices.