Impact of the introduction of computerised physician order entry (CPOE) on the surveillance of restricted antimicrobials and compliance with policy

Abstract

Background Prescribers at a 400‐bed metropolitan teaching hospital applied for approval to prescribe restricted antimicrobials using Guidance DS® (GDS), an electronic antimicrobial approval system (EAAS). The implementation of Cerner Millennium® (CM), a computerised physician order entry system (CPOE), necessitated a new but cumbersome workflow for prescribers. This prompted an evaluation of the value of a stand‐alone EAAS, which has no interface with a CPOE, for antimicrobial stewardship. Aim This study compares the performance of an EAAS and CPOE, used alone and in combination, for surveillance of restricted antimicrobials and compliance with antimicrobial restriction policy. Method General medical and surgical patients prescribed restricted antimicrobials over three defined periods were retrospectively recruited; period one (P1) used GDS plus National Inpatient Medication Chart, period two (P2), GDS plus CM, and period three (P3), CM alone. For each period, 100 medical and 100 surgical restricted antimicrobial orders were collected. Data collection included prescribing date, indication, approvals obtained, and time to approval. Surveillance rate and compliance was compared. Results The introduction of CM improved surveillance from 10.5% (P1) to 65% (P2) and 100% (P3) via a CM reporting module (p < 0.0001). Compliance improved from 6% (P1), to 55% (P2) and 76% (P3) (p < 0.0001). Documentation of a clear/complete indication improved from 10% (P1) to 56.5% (P2) and 76.5% (P3) (p < 0.0001). Approvals obtained within 24 h of prescribing improved from 61.9% (P1), to 96.9% (P2), and 100% (P3). Conclusion Cerner Millennium®, with customisation, optimises surveillance and significantly improves compliance with policy, negating the need for a stand‐alone EAAS.

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

“…Two types of alerts were identified in the studies: interruptive ‘pop-ups’ visualized in a patient’s EHR ( n = 11) or an electronic notification generated in the background to inform a pharmacist or specialist team ( n = 4). Eleven studies reported outcomes following introduction of EHR pop-ups, three in the peri-operative setting 14 , 16 , 17 and eight in the medical setting. 10 , 18–24 Peri-operative alerts focused on reminding theatre staff to administer prophylactic antimicrobials at the correct dose and time, whilst in the medical setting alerts were more varied, used to inform healthcare practitioners of the presence of a care bundle or guideline or the risks associated with a particular therapy, or to remind prescribers to complete all elements of the gold standard antimicrobial authorization to administer e.g.…”

“… 12 , 13 , 20 , 23 , 25 , 26 Interventions to restrict access to ‘non-formulary’ or reserve line antimicrobials were reported in five studies. 9 , 11 , 13 , 14 , 27 Methods to permit access were granted in one of two ways: electronically where the prescriber inputted details such as the indication or justification to gain approval, 9 , 11 , 13 or secondly by getting another healthcare professional to countersign the prescription. 14 , 27 …”

“…Six papers reported readmission rates due to all causes 9 , 20 , 22 , 25 , 28 , 31 whilst one reported those only related directly to the infection. 14 …”

The protected antimicrobial process in a University Teaching Hospital: a qualitative interview study exploring the knowledge, attitudes, and experiences of healthcare professionals

“…The literature confirms that electronic forms in healthcare ensure accurate data collection, easy manageability, consistent form rendering and interoperability [ 31 ]. The introduction of computerized restricted antimicrobial forms resulted in a reduction in antibiotic consumption [ 32 , 33 ] in two studies and an increase in compliance with the process of antimicrobial protection, surveillance and restricted antimicrobial approvals obtained within 24 h in another study [ 34 ]. However, further literature reports that a common reason for the failure of electronic solutions in healthcare is that clinicians will not use the technology [ 35 ].…”

Methods in pharmacy practice research – using the palette ingeniously

“…hospital) already collects for clinical and administrative reasons. Such clever use of methods can be seen in this issue in the study by Metcalfe et al . addressing the impact of the introduction of computerised physician order entry (CPOE) on the surveillance of restricted antimicrobials and compliance with policy.…”