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

Abstract

Objectives To identify interventions implemented in hospital electronic prescribing systems and the outcome measures used to monitor their impact. Methods We systematically searched CINAHL, EMBASE, Google Scholar and Medline using keywords in three strands: (i) population: hospital inpatient or emergency department; (ii) intervention: electronic prescribing functionality; and (iii) outcome: antimicrobial stewardship. The interventions were grouped into six themes: alerts, order sets, restriction of access, mandated documentation, embedded guidelines and automatic prescription stop. The outcome measures were organized into those that measure the quality or quantity of prescribing or clinical decision support (CDS) activity. The impact of each intervention reported was grouped into a positive, negative or no change. Results A total of 28 studies were eligible for inclusion. There were 28 different interventions grouped into the six themes. Alerts visible to the practitioner in the electronic health record (EHR) were most frequently implemented (n = 11/28). Twenty different outcome measures were identified, divided into quality (n = 13/20) and quantity outcomes (n = 4/20) and CDS activity (n = 3/20). One-third of outcomes reported across the 28 studies showed positive change (34.4%, n = 42/122) and 61.4% (n = 75/122) showed no change. Conclusions The most frequently implemented interventions were alerts, the majority of which were to influence behaviour or decision-making of the practitioner within the EHR. Quality outcomes were most frequently selected by researchers. The review supports previous research that larger well-designed randomized studies are needed to investigate the impact of interventions on AMS and outcome measures to be standardized.

Antimicrobial Stewardship: A Correct Management to Reduce Sepsis in NICU Settings

“…A neonatal DDD has been proposed for the eight most commonly used antimicrobials, considering an average weight of 2 kg, but it has not been validated [ 12 ]. The usage of electronic medical records and clinical decision support systems to perform AMS activities seems to be an important avenue for time optimization [ 82 ].…”

The development of a complex digital and behavioural Antimicrobial Stewardship intervention for hospitals in England

“…Interventions to encourage antimicrobial stewardship (AMS) are therefore consistently promoted at the highest levels of global health governance [1] and through several national health policies [2]. Evidence has shown that focusing antimicrobial prescribing following empirical treatment, among other AMS interventions, can increase effective prescribing and improve clinical outcomes such as reducing mortality and length of hospital stay [3,4,5,6]. For instance, in a feasibility trial, the Antimicrobial Review Kit (ARK), a behavioural intervention to promote the safe stopping of antibiotics when no longer required, decreased antimicrobial use in hospital settings [7].…”

“…A systematic scoping review exploring the appropriate use of antimicrobials through hospital ePrescribing systems, [18] Related conceptual work [4,19] A systematic review of the effect of digital antimicrobial stewardship programmes on antimicrobial usage, length of stay, mortality, and cost [3]. Broader literature on the development of digital health technology tools and AMS tools including ARK [13].…”