Antimicrobial Stewardship Program Implementation of a Quality Improvement Intervention Using Real-Time Feedback and an Electronic Order Set for the Management of Staphylococcus aureus Bacteremia

Abstract

Antimicrobial stewardship programs can optimize the management of Staphylococcus aureus bacteremia by integrating information technology and microbiology laboratory resources. This study describes our experience implementing an intervention consisting of real-time feedback and the use of an electronic order set for the management of S. aureus bacteremia. Infect Control Hosp Epidemiol 2018;39:346-349.

Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures

“…These more complex order sets were adopted in five studies. 12 , 13 , 20 , 23 , 25 , 26 Interventions to restrict access to ‘non-formulary’ or reserve line antimicrobials were reported in five studies. 9 , 11 , 13 , 14 , 27 Methods to permit access were granted in one of two ways: electronically where the prescriber inputted details such as the indication or justification to gain approval, 9 , 11 , 13 or secondly by getting another healthcare professional to countersign the prescription.…”

“…Mortality was found to be measured from a fixed time period from the intervention ( n = 3/9)—one at 14 days ( n = 1/9) 1 and two at 30 days ( n = 2/9), 21 , 22 whilst five studies adopted the more flexible ‘in-hospital mortality’ determined as patient death within that episode of inpatient care. 11 , 12 , 24 , 28 , 30 One additional paper did not provide information regarding how mortality rate was determined. 3 Readmission rates were used in seven studies.…”

“…One paper described failure as the ‘requirement to broaden therapy from initial choice’ 20 and one used the number of monthly episodes of clinical failure per 1000 at-risk patient days. 12 For measures of mortality, readmission rates, acquisition of another infection and clinical failure, there was considerable divergence in the methods used to calculate these, whilst for those reported as rates there is further variation in the denominator used in the included papers.…”

“…There was some consistency in the methodology used to measure LOS with 10/12 papers reporting total duration of inpatient hospital stay and the remaining 2 determining ‘infection-related length of stay’. 11 , 25 Divergence was observed in the reporting of DOT, with three studies reporting total DOT and seven reporting this outcome as a rate using one of four denominators: 100 patient days, 21 1000 patient days, 13 , 25 , 28 , 31 1000 at-risk patient days 12 and 1000 occupied bed days. 11 Three studies investigated the antibiotic consumption reported in all cases as antibiotic expenditure.…”

Leveraging Information Technology to Hardwire Diagnostic Stewardship

“…Computerized ordering is effective in reducing medication errors. Electronic order sets are useful in management of clinical conditions like bacteremia and in fostering antimicrobial stewardship [5][6][7]. Automated alerts have been used to encourage diagnostic stewardship for an accurate diagnosis of Clostridium difficile infection (CDI) [8].…”