Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

Abstract

SynopsisThe implementation of electronic prescribing and medication administration systems (EPMAs) is a priority for hospitals and a potential component of antimicrobial stewardship (AMS). ObjectivesThis study aimed to identify software features within EPMAs that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features. MethodsA questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann Whitney U test. ResultsResponses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). 59% of pharmacists had experience of EPMA in their hospitals compared to 35% of microbiologists. Pharmacists assigned higher priority to: indication prompt (p<0.001), allergy checker (p=0.003) treatment protocols (p=0.003), drug-indication mismatch alerts (p=0.031) and prolonged course alerts (p=0.041); and lower priority to a dose checker for adults (p=0.02) and an interaction checker (p<0.05), than microbiologists. A "soft stop" functionality was rated essential or a high priority by 89% of respondents. Potential EPMA software features were expected to have the greatest impact on stewardship, treatment efficacy and patient safety outcomes with lowest impact on Clostridium difficile infection (CDI), antimicrobial resistance and drug expenditure. ConclusionsThe survey demonstrates key differences in health professionals' opinions of different healthcare benefits of EPMA but a consensus of anticipated positive impact on patient safety and antimicrobial stewardship.

Antimicrobial stewardship and the hospital nurse and midwife: how do they perceive their role?

“…We would argue that outputs from such systems, for example, prescription surveillance of missed doses,22 could also prompt action from nursing staff, though potential barriers to interprofessional collaboration have to be overcome. In addition, Wentzel et al note that to perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions, and comment that hospital information infrastructure may be unsupportive of AS programme-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date and insufficiently supportive of AS programme awareness 23…”

Quality of antimicrobial prescribing improved by the introduction of ePrescribing at Auckland City Hospital

“…24 Alert fatigue is a recognised risk of ePrescribing systems and must be balanced against added functionality and prescriber requirements to optimise possible outcomes. 15 Alert fatigue may have contributed to the difference seen between indication and stop and review date documentation. We also found that 12% of prescriptions had the mandatory indication 'over-ridden' using blank spaces or non-specific terms such as 'infection'.…”

Linking individual‐level data on diagnoses and dispensing for research on antibiotic use: Evaluation of a novel data source from English secondary care

“…There remains a pressing need for comprehensive and complete data to evaluate the intended and unintended impacts of AMS programmes in hospitals. However, although hospitals are clearly setting the course for e‐prescribing, full adoption and availability for secondary use might still take years. For now, linking HES to pharmacy data provides a potential mechanism to investigate some patient‐level drug usage across NHS hospitals.…”