Piperacillin-Tazobactam Order Panel Updates on Operational Efficiency & Outcomes: Pre-Post Analysis

Sunday, March 22, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 05

Jennifer Schultheis, PharmD, BCPS, BCCCP, FCCM

Duke University Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.
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Paul Chan, PharmD

PGY2 Cardiology Pharmacy Resident
Duke University Hospital

Disclosure information not submitted.
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Connor Deri, PharmD, BCIDP

Clinical Pharmacist, Infectious Diseases
Duke University Hospital

Disclosure information not submitted.
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Daniel Gilstrap, MD

Assistant Professor of Medicine, DUH CSU Medical Director for Critical Care
Duke University Hospital

Disclosure information not submitted.
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Rebekah Moehring, MD, MPH, FSHEA, FIDSA

Associate Professor of Medicine; Medical Director, Duke Antimicrobial Stewardship and Evaluation Tea
Duke University Hospital

Disclosure information not submitted.
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Julie Magraw, PharmD

PharmD Candidate
UNC Eshelman School of Pharmacy

Disclosure information not submitted.
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Emily Ong, PharmD

PharmD Candidate
UNC Eshelman School of Pharmacy

Disclosure information not submitted.
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Alexander Reed, MS

Biostatistician II
Duke University School of Medicine

Disclosure information not submitted.
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Alice Parish, MSPH

Biostatistician III
Duke University School of Medicine

Disclosure information not submitted.

Introduction: Optimizing beta-lactam infusion strategies, such as extended infusion piperacillin/tazobactam (TZP), improves pharmacokinetic target attainment and may improve clinical outcomes, but implementation is often hindered by ordering inaccuracies and logistical barriers. This study assessed the impact of an electronic order panel redesign on operational efficiency and clinical outcomes in critically ill patients receiving TZP.

Methods: This retrospective, single-center, pre-post cohort study followed implementation of an updated TZP order panel in adult intensive care units at a large, tertiary care academic medical center. Updates included an embedded loading dose, preferential administration instructions when ordered concurrently with vancomycin, extended infusion maintenance dosing and a cascading dose frequency based on renal function. Pre-specified outcomes were compared before and after implementation.

Results: A total of 655 patients met inclusion: 353 in the pre-cohort and 302 in the post-cohort. Post-implementation, the rate of appropriate TZP orders improved significantly (88.4% vs 80.5%; difference in proportions of 0.08; 95% CI, 0.02-0.14, P = 0.008), driven by reductions in required order correction. Use of loading doses (difference in proportions 0.76, 95% CI 0.7-0.81), timely administration of subsequent doses (difference in proportions of 0.39; 95% CI, 0.12-0.66), and appropriate sequencing of TZP relative to vancomycin (difference in proportions 0.09, 95% CI 0.01-0.16) also significantly improved. In a clinical subgroup of patients with positive gram-negative cultures, no significant difference in in-hospital mortality was observed (P = 0.91), although modest reductions in length of stay, vasopressor duration and mechanical ventilation duration were seen.

Conclusions: The implementation of an optimized TZP order panel significantly improved order accuracy, resulted in fewer order modifications, increased use of loading doses, and improved sequential administration of TZP in relation to vancomycin in critically ill patients. The operational benefits observed suggest that thoughtful design of computerized order entry systems can drive practice change. Broader implementation may support antimicrobial stewardship efforts and workflow improvements in high-acuity care settings.