Irrespective of the potential decrease in length of stay and mortality rate when a preprinted order is used, there are additional potential benefits of this tool. When the preprinted order was used, patients in this study were 3 times more likely to have their pneumococcal vaccination status formally assessed and documented in the medical chart. Use of this vaccine has been shown to decrease admission rates for community- acquired pneumonia (hazard ratio = 0.66). Also, for 52% of the patients for whom the preprinted order was used, the severity of pneumonia was assessed objectively with the pneumonia severity index; in contrast, only 3% of those for whom the preprinted order was not used had such an assessment. Use of an objective system for scoring severity of illness (such as the pneumonia severity index or the CURB-65) has been shown to decrease unnecessary admissions of patients who can be managed as outpatients. Therefore, the potential impact of using preprinted orders to free up hospital resources is great.

The retrospective design of this study limited the data collection to what was documented in the original patient care record. Furthermore, because the statistical analyses performed were not defined a priori, there may have been some inadver­tent bias in the selection of analytical tests. viagra 50 mg

The small sample size may have led to a type 2 statistical error (failure to reject the null hypothesis even though the null hypothesis was actually false), specifically in terms of the differ­ence in inappropriate prescribing of levofloxacin between the 2 groups.

This institution would benefit from futher research to determine why the preprinted order for community-acquired pneumonia is not being utilized to its fullest. In addition, it should be determined why physicians who do use the preprinted order are not completing all 3 sections correctly. A survey of practising physicians, to gather feedback about the existing preprinted order and suggestions of ways to improve it, may be helpful to identify areas for improvement. The preprinted order could then be updated, and a future study of similar design undertaken to assess any improvement in adherence to all sections of the form.


At the UHNBC, the preprinted order for community- acquired pneumonia was not being utilized to the desired extent during the study period. When the form was used, it resulted in significantly better adherence to IDSA-ATS guide­lines for empiric therapy. Conversely, when the form was not used, clinical aspects of a patient’s therapy for community- acquired pneumonia were missed. Increased use of the preprinted order would likely result in more effective triage and more consistent assessment of vaccination history before discharge. Further research is needed to discover the reasons why the preprinted order is not being used, and modification of the current preprinted order is warranted to increase adherence and to maximize the benefits of the preprinted order.  canadian pharmacy viagra