“I Never Would Have Caught That Before”: Pharmacist Perceptions of Using Clinical Decision Support for Antimicrobial Stewardship in the United States

Giuliano, Christopher; Binienda, Juliann; Kale-Pradhan, Pramodini; Fakih, Mohamad G.

doi:10.1177/1049732317750863

Cited by 11 publications

(26 citation statements)

References 33 publications

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“…The 75 non-review, non-opinion articles used a variety of metrics to evaluate the usability and acceptability of their CDS tools, with many using more than one metric. The most common evaluation was via interviews (n=29) 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 , followed by surveys or questionnaires (n=16) 27 29 50 53 55 56 57 58 59 60 61 62 63 64 65 66 . Other qualitative feedback responses were obtained by focus groups or workshops (n=5) 43 57 61 67 68 .…”

Section: Resultsmentioning

confidence: 99%

“…A strength of this study is that it included a wide array of healthcare professionals’ experiences including physicians 37 62 , advanced practice providers 17 18 63 , nurses 90 92 , pharmacists 29 33 , midwives 38 , and paramedics 59 . We also surveyed a heterogenous mix of publication types including systematic reviews, randomized trials, quality improvement initiatives, and opinion pieces.…”

Section: Discussionmentioning

confidence: 99%

“…For example, one study found that a large number of antibiotic susceptibility alerts were already addressed by standard workflow (e.g., the clinician reviewing new culture results and adjusting empiric antibiotics appropriately), so early alerts just contributed to alert burden [84]. Another study noted the pharmacists using a tool for antibiotic stewardship were frustrated by automatic log-offs [33]. Additionally, a CDS tool for screening for pregnancy complications in Ghana was criticized by clinicians for adding up to 30 minutes to an antenatal visit [38].…”

Section: Make It Easy -Workflow Efficiency and Integrationmentioning

confidence: 99%

“…An investigation into why clinician adoption of a CDS tool was only 4-14% identified lack of buy-in as one of the factors deterring use [93]. Some studies noted concerns that CDS threatened clinician autonomy [67] or that CDS use would be monitored for punitive reasons [33]. For example, users were offended by the CDS prompt to use basal-bolus insulin when only sliding scale insulin had been ordered [67], demonstrating that even when CDS is supporting the evidence-based regimen the prompt needs to be palatable to clinicians.…”

Section: I'm a Believer -Clinician Buy-inmentioning

confidence: 99%

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Clinical Decision Support and Implications for the Clinician Burnout Crisis

Janković

Chen

2020

Yearb Med Inform

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Objectives: This survey aimed to review aspects of clinical decision support (CDS) that contribute to burnout and identify key themes for improving the acceptability of CDS to clinicians, with the goal of decreasing said burnout. Methods: We performed a survey of relevant articles from 2018-2019 addressing CDS and aspects of clinician burnout from PubMed and Web of Science™. Themes were manually extracted from publications that met inclusion criteria. Results: Eighty-nine articles met inclusion criteria, including 12 review articles. Review articles were either prescriptive, describing how CDS should work, or analytic, describing how current CDS tools are deployed. The non-review articles largely demonstrated poor relevance and acceptability of current tools, and few studies showed benefits in terms of efficiency or patient outcomes from implemented CDS. Encouragingly, multiple studies highlighted steps that succeeded in improving both acceptability and relevance of CDS. Conclusions: CDS can contribute to clinician frustration and burnout. Using the techniques of improving relevance, soliciting feedback, customization, measurement of outcomes and metrics, and iteration, the effects of CDS on burnout can be ameliorated.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Make It Easy -Workflow Efficiency and Integrationmentioning

confidence: 99%

Section: I'm a Believer -Clinician Buy-inmentioning

confidence: 99%

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Clinical Decision Support and Implications for the Clinician Burnout Crisis

Janković

Chen

2020

Yearb Med Inform

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“…Similarly, the limited access to resources including time, personnel, and funds, 22,31 hindered the implementation and sustainability of ASPs. 32 During the collaborative project, the HBT provided many of these resources, mitigating some antibiotic stewardship-related costs for nursing homes.…”

Section: Discussionmentioning

confidence: 99%

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

Seshadri

Felsen

Sellers

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: To describe nursing home staff experiences and perceptions of the factors that impact the sustainability of an antibiotic stewardship program (ASP). Methods: Using a qualitative descriptive design, semistructured interviews with staff at 9 not-for-profit nursing homes with an established ASP were conducted and audio recorded. De-identified transcriptions of the interviews were coded using a sustainability framework and were analyzed to identify themes. Results: Interviews were conducted with 48 clinical and administrative staff to elicit their perceptions of the ASPs, and 7 themes were identified. ASPs were perceived to be resource intensive and “data driven,” requiring access to and interpretation of data that are not readily available at many nursing homes. Though motivated and committed, ASP champions felt that they could not single-handedly sustain the program. Attending to daily clinical needs (ie, “fires”) made it hard to progress beyond implementation and to reach step 2 of sustainability. Longstanding treatment habits by external prescribers and regulations were believed to impede ASP efforts. Partnerships with an external consultant with antibiotic stewardship expertise were considered important, as was the need for internal leadership support and collaboration across disciplinary boundaries. Participants felt that consistent and ongoing education on antibiotic stewardship at all staff levels was important. Conclusions: Although many interconnected factors impact the sustainability of an ASP, nursing homes may be able to sustain an ASP by focusing on 3 critical areas: (1) explicit support by nursing home leadership, (2) external partnerships with professionals with antibiotic stewardship expertise and internal interprofessional collaborations, and (3) consistent education and training for all staff.

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The role of organizational culture in health information technology implementations: A scoping review

Rajamani

Hultman

Bakker

et al. 2021

Learning Health Systems

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Introduction The exponential growth in health information technology (HIT) presents an immense opportunity for facilitating the data‐to‐knowledge‐to‐performance loop which supports learning health systems. This scoping review addresses the gap in knowledge around HIT implementation contextual factors such as organizational culture and provides a current state assessment. Methods A search of 13 databases guided by Arskey and O'Malley's framework identified content on HIT implementations and organizational culture. The Consolidated Framework for Implementation Research (CFIR) was used to assess culture and to develop review criteria. Culture stress, culture effort, implementation climate, learning climate, readiness for implementation, leadership engagement, and available resources were the constructs examined. Rayyan and Qualtrics were used for screening and data extraction. Results Fifty two studies included were mainly conducted in Academic Health Centers (n = 18, 35%) and at urban locations (n = 50, 96%). Interviews frequently used for data collection (n = 26, 50%) and guided by multiple frameworks (n = 34). Studies mostly focused on EHR implementations (n = 23, 44%) followed by clinical decision support (n = 9, 17%). About two‐thirds (n = 34, 65%) reflected culture stress theme and 62% (21 of 34) acknowledged it as a barrier. Culture effort identified in 27 studies and was a facilitator in most (78%, 21 of 27). Leadership engagement theme in majority studies (71%, n = 37), with 35% (n = 13) noting it as a facilitator. Eighty percent (42 studies) noted available resources, 12 of which identified this as barrier to successful implementation. Conclusions It is vital to determine the culture and other CFIR inner setting constructs that are significant to HIT implementation as facilitators or barriers. This scoping review presents a limited number of empirical studies in this topic highlighting the need for additional research to quantify the effects of culture. This will help build evidence and best practices that facilitate HIT implementations and hence serve as a platform to support robust learning health systems.

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“I Never Would Have Caught That Before”: Pharmacist Perceptions of Using Clinical Decision Support for Antimicrobial Stewardship in the United States

Cited by 11 publications

References 33 publications

Clinical Decision Support and Implications for the Clinician Burnout Crisis

Clinical Decision Support and Implications for the Clinician Burnout Crisis

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

The role of organizational culture in health information technology implementations: A scoping review

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