Impact of a computerized physician order entry (CPOE)-based antibiotic stewardship intervention on the treatment duration for pneumonia and COPD exacerbations

Leo, Fabian; Bannehr, Marwin; Valenta, Swantje; Lippeck, Madlen; Pachl, Sebastian; Steib-Bauert, Michaela; Semper, Hannes; Grohé, Christian

doi:10.1016/j.rmed.2021.106546

Cited by 5 publications

(18 citation statements)

References 13 publications

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“…The included studies have been classified into four groups: 13 articles involved IP settings without a pharmacist as a part of an AMS-MDT intervention [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], 19 were carried out in IP settings with the inclusion of a pharmacist as a part of the intervention team [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], eight articles engaged OP without a pharmacist [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ], while eight involved OP settings with a pharmacist [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Forty-one articles were from d...…”

Section: Resultsmentioning

confidence: 99%

“…Of those, seven scored high risk [ 33 , 34 , 46 , 57 , 59 , 63 , 67 ], three scored low risk [ 28 , 32 , 60 ], with one article only found to have some concerns [ 58 ]. On the other hand, the remaining 37 articles were non-randomized before and after methodology and were assessed using the ROBINS-1 assessment tool [ 24 , 25 , 26 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 61 , 62 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ]. Out of those 37, 29 were at moderate risk of bias [ 24 , ...…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, the remaining 37 articles were non-randomized before and after methodology and were assessed using the ROBINS-1 assessment tool [ 24 , 25 , 26 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 61 , 62 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ]. Out of those 37, 29 were at moderate risk of bias [ 24 , 25 , 29 , 30 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ,…”

Section: Resultsmentioning

confidence: 99%

“…Of the identified interventions, twelve were captured in the IP setting [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 37 , 38 , 39 , 40 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 ] while 13 were in the OP setting [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ], with 7 common interventions between the two settings. Those interventions were prospective and audit with direct intervention [ 37 , 38 , 42 , 44 , 45 , 47 , 48 , 49 , 50 , 53 , …”

Section: Resultsmentioning

confidence: 99%

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Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

et al. 2022

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Antimicrobial stewardship interventions are targeted efforts by healthcare organizations to optimize antimicrobial use in clinical practice. The study aimed to explore effective interventions in improving antimicrobial use in hospitals. Literature was systemically searched for interventional studies through PubMed, CINAHL, and Scopus databases that were published in the period between January 2010 to April 2022. A random-effects model was used to pool and evaluate data from eligible studies that reported antimicrobial stewardship (AMS) interventions in outpatient and inpatient settings. Pooled estimates presented as proportions and standardized mean differences. Forty-eight articles were included in this review: 32 in inpatient and 16 in outpatient settings. Seventeen interventions have been identified, and eight outcomes have been targeted. AMS interventions improved clinical, microbiological, and cost outcomes in most studies. When comparing non-intervention with intervention groups using meta-analysis, there was an insignificant reduction in length of stay (MD: −0.99; 95% CI: −2.38, 0.39) and a significant reduction in antibiotics’ days of therapy (MD: −2.73; 95% CI: −3.92, −1.54). There were noticeable reductions in readmissions, mortality rates, and antibiotic prescriptions post antimicrobial stewardship multi-disciplinary team (AMS-MDT) interventions. Studies that involved a pharmacist as part of the AMS-MDT showed more significant improvement in measured outcomes than the studies that did not involve a pharmacist.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

et al. 2022

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“…Another CDSS-based intervention by Leo and colleagues designed a multi-faceted CDSS tool comprising preconfigured antibiotic dosing and intervals, a “soft stop” duration of three days with a prompt for re-evaluation and action, and commentary listing guideline-recommended durations of therapy for CAP, HAP, and acute COPD exacerbations. The duration of antibiotic therapy significantly decreased from approximately 9.59 to 7.25 days after adoption of the CDSS intervention, with the guideline-adherent duration improving to 69.3% of patients from a pre-intervention rate of 35.8% [ 60 ]. While the development of such supportive technology requires investment upfront, well-designed CDSS and order sets with specific regimen recommendations are advantageous for stewardship programs due to the low need for maintenance activity after creation, ability to capture a greater number of patients compared with individual review, and ancillary potential to educate prescribers and influence practice patterns.…”

Section: Interventional Approach To Stewardshipmentioning

confidence: 99%

Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies

2022

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Inappropriate antibiotic use and associated consequences, including pathogen resistance and Clostridioides difficile infection, continue to serve as significant threats in the United States, with increasing incidence in the community setting. While much attention has been granted towards antimicrobial stewardship in acute care settings, the transition to the outpatient setting represents a significant yet overlooked area to target optimized antimicrobial utilization. In this article, we highlight notable areas for improved practices and present an interventional approach to stewardship tactics with a framework of disease, drug, dose, and duration. In doing so, we review current evidence regarding stewardship strategies at transitional settings, including diagnostic guidance, technological clinical support, and behavioral and educational approaches for both providers and patients.

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Clinical decision support systems for chronic obstructive pulmonary disease (COPD) in hospitals: A systematic review

Bamgboje-Ayodele,

Borg,

McPhail

et al. 2023

DIGITAL HEALTH

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Objectives To synthesise the literature on clinical decision support (CDS) systems for chronic obstructive pulmonary disease (COPD). We aimed to (1) describe existing COPD CDS systems that have been designed, developed or are being used in practice, (2) describe the impact of COPD CDS systems on outcomes and (3) identify barriers and facilitators to implementation of COPD CDS systems. Methods Five databases were searched to identify relevant studies. All studies in English that described clinician-facing COPD CDS systems designed for, or implemented in, hospitals and hospital-in-the-home settings were included. A qualitative narrative synthesis was undertaken, guided by the RE-AIM framework ( Reach, Effectiveness, Adoption, Implementation and Maintenance). Results Twelve studies reporting the use of CDS in hospital ( n = 7) and hospital-in-the-home ( n = 5) settings were included. Implementation efforts to reach target users were scantly reported, and low-to-medium adoption rates were observed. The reported effectiveness of the CDS systems was mixed. Only one study reported facilitators to the implementation of CDS systems, none reported on barriers to the implementation of CDS systems, and none reported any information on successful strategies to maintain implementation of CDS systems. Conclusion The use of CDS systems in the management of patients with COPD in hospital-related settings is an important emerging field of research. Evidence suggests that the field has largely focused on systems targeted at physicians, often with incomplete descriptions and limited evaluations. Many opportunities to optimise and evaluate the implementation and use of COPD CDS systems in hospital settings remain, including robust evaluation of their impact on patient, clinician and health service outcomes.

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Impact of a computerized physician order entry (CPOE)-based antibiotic stewardship intervention on the treatment duration for pneumonia and COPD exacerbations

Cited by 5 publications

References 13 publications

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies

Clinical decision support systems for chronic obstructive pulmonary disease (COPD) in hospitals: A systematic review

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