Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting

Westphal, Jean‐Frédéric; Jehl, F.; Javelot, Hervé; Nonnenmacher, Cathy

doi:10.1002/pds.2078

Cited by 21 publications

(23 citation statements)

References 32 publications

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“…Implementation of e-prescribing systems in hospitals presents a unique opportunity to improve the quality of antimicrobial prescribing and to facilitate AMS. [5][6][7][8][9][10] Evidence for the benefits of AMS functionality within e-prescribing systems comes from published research studies demonstrating positive impact on outcomes including increased guideline adherence 11,12 and effective initial therapy 13 or reductions in antimicrobial prescribing, 14,15 resistance, 16,17 dosing errors, 8 length of hospital or ICU stay 14,18 and mortality. 12,13,19 However, many of these information systems were created on a small scale in individual hospitals or groups of institutions and few reports cover the full potential range of software features that enable AMS.…”

mentioning

confidence: 99%

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

Hand

Cumming

Hopkins

et al. 2016

J. Antimicrob. Chemother.

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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.

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mentioning

confidence: 99%

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

Hand

Cumming

Hopkins

et al. 2016

J. Antimicrob. Chemother.

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“…In the period using paper-based guidelines, only 15.43% of patients were prescribed antibiotic categories and 32.9% of patients were administrated according to time course recommended by the guidelines during antibiotic prophylaxis of surgical operations. It was reported that the most predictable impact was achieved when the guidelines are made available through computer-based reminders that are integrated into the clinician's workflow and provide therapeutic information to prescribers ‘just-in-time’ to influence the decision at the time of clinical decision [13], [14], [15], [26]. Shojania [27] developed a system in which the CDC recommendations for vancomycin use were presented online to the surgeon at the time of drug ordering on a hospital's computer-based order entry system, which found that surgeons who were randomly assigned to receive the intervention wrote 32% fewer orders for vancomycin compared with control group.…”

Section: Discussionmentioning

confidence: 99%

“…So the key point to prevent SSIs is to improve the dependence on the guidelines for the prevention of SSIs. In addition, some studies have reported that making guidelines or decision supports can supply therapeutic information to prescribers ‘just-in-time’ to influence the decision at the time of clinical decision, so that surgeon is likely to apply it [13], [14], [15].…”

Section: Introductionmentioning

confidence: 99%

DRUGS System Enhancing Adherence of Chinese Surgeons to Antibiotic Use Guidelines during Perioperative Period

Yang

Zhao²,

Wang

et al. 2014

PLoS ONE

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ObjectiveIrrational use of antimicrobial agents for preventing postoperative SSIs is a common phenomenon in China, which results in more bacterial resistance, higher hospital infection rates, extra costs of antimicrobial agents. The aim of the study is to evaluate the effect of Drug Rational Usage Guidelines System (DRUGS) on the surgeon's prescription behavior of antimicrobial agents.Methods10 common surgical operations which included 1543 cases (where 778 cases using paper-based guidelines and 765 cases using DRUGS) were selected and their demographic and clinical data were collected. The selected operations include thyroid resection, breast mass resection, myomectomy, etc. The evaluation criteria were antibiotic administrative categories, the time of initial dose, duration of administration, length of stay, the costs of antibiotics, SSIs and drug adverse reactions(ADR).ResultsThe antimicrobial agents were mostly administrated within 0.5 h to 2 h before incision, 656 patients (85.75%) were intervened with DRUGS and 256 (32.90%) with paper-based guidelines according to the protocol. For the clean wounds incision, 547 patients (91.62%) were within 24 h of withdrawal antibiotics with using paper-based guidelines versus 91 (14.79%) with using DRUGS. A total of 19 kinds of antibiotics were used in the 1543 cases. The leading three on the list of frequency were piperacillin and sulbactam sodium, cefathiamidine and cefoperazone. While after the intervention, the list of frequency changed to cefazolin, cefathiamidine, cefoperazone. The average hospital stay was (7.00±4.31)d with paper-based guidelines and (2.54±1.57)d with DRUGS, respectively. The average cost of antibiotics was ¥(3481.36±2584.46) with paper-based guidelines and ¥(1693.39±1478.27) with DRUGS, respectively. However, there were no significant differences in the incidence of SSIs and ADR between two groups.ConclusionIn this study, the increased availability of antibiotic guidelines at the time of drug ordering, combined with DRUGS, was associated with an enhanced surgeon adherence to guidelines.

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“…18 They concluded that the presentation of antibiotic guidelines at the time of drug ordering via the CPOE in combination with scheduled educational reinforcement enhanced physician adherence to specific aspects of guidelines (choice, dose, duration), although overall, there was no significant difference in the proportion of nonadherent antibiotic orders in the postintervention period. They suspect physician beliefs regarding guidelines may play a role in this finding.…”

Section: Computerized Physician Order Entrymentioning

confidence: 96%

Technology Implementation Impacting the Outcomes of Patients with CAP

Vines

Dean

2012

Semin Respir Crit Care Med

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Community-acquired pneumonia (CAP) combined with influenza is the eighth leading cause of death in the United States. This article examines the literature to understand and describe whether technology implementation has impacted the outcomes of patients with CAP. We conducted an electronic search of PubMed and scanned references of articles meeting inclusion criteria. Twenty-six articles were included in this review. We surveyed this literature for answers to the following questions: Can technology be used to improve quality of care and guideline compliance in CAP? How can we overcome the behavioral bottleneck that prevents adoption of computerized decision support systems? How reliable are our data in the era of electronic medical records? What are the risks associated with technology implementation? No articles demonstrated that technology implementation improves outcomes in the care of patients with CAP.

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Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting

Abstract: In this study, the increased availability of antibiotic guidelines at the time of drug ordering, combined with a periodical reinforcement educational round, was associated with an enhanced physician adherence to these guidelines.

Cited by 21 publications

References 32 publications

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

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

DRUGS System Enhancing Adherence of Chinese Surgeons to Antibiotic Use Guidelines during Perioperative Period

Technology Implementation Impacting the Outcomes of Patients with CAP

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