The role of electronic health record and “add-on” clinical decision support systems to enhance antimicrobial stewardship programs

Abstract

Increasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.

Empfehlungen des Antibiotic-Stewardship Teams – eine Analyse unter Routinebedingungen eines Universitätsklinikums

“…Diskutiert wird international auch, ob "Prescription authorisation", das heißt die Freigabe der Antiinfektivaverordnungen durch das ABS-Team, ein Vorteil gegenüber dem reinen Empfehlungscharakter haben [19,29]. Die Einbeziehung elektronischer Lösungen könnte weitere Ansatzpunkte für die Unterstützung von ABS-Programmen ermöglichen [30].…”

Antimicrobial stewardship staffing: How much is enough?

“…71 Despite the potential effectiveness and efficiency of antibiotic stewardship IT systems, resource allocation is often lacking, as is analytic support for the data generated. 37,[95][96][97] The open question of "who counts" when evaluating antibiotic stewardship staffing is especially important for smaller medical facilities. 54,57 The VHA and other authors have called for future studies to facilitate the recruitment of less "traditional" ASP personnel (including hospitalists, nursing staff and tele-ASPs), particularly for institutions where infectious disease specialists are simply not available, including many long-term care (LTC) settings.…”

“…129 ASPs presumably require more resources in the "initiation" phase (particularly for IT support) compared to an established program in the "maintenance" phase of program development. 97 Data evaluating how complexity and intensity of care as well as the presence of specialty services are limited, but the effect of these variables on antimicrobial use and need for risk adjustment have been examined previously. [130][131][132] It follows that staffing ratios would similarly require calibration to reflect differing needs.…”

“…Technology support is required to integrate ASP tools to enhance the vital human components of ASPs, and resources for software as well as support likewise deserve attention. 97 Further studies are needed to characterize human resource parameters for antibiotic stewardship across the healthcare continuum, which should both further refine inpatient standards and prompt yet another call to action for outpatient stewardship staffing benchmarks. 57,141,142 Zahn et al 143 could not be more right in stating, "Physicians performing infection control and antimicrobial stewardship work should be compensated for these activities (p 355)."…”

Novel methodology to measure pre-procedure antimicrobial prophylaxis: integrating text searches with structured data from the Veterans Health Administration’s electronic medical record

“…Identifying whether antimicrobial prophylaxis was administered has historically relied on manual chart review because an electronic method has several challenges. Some institutions designed their electronic medical record (EMR) to include structured data fields for ongoing antimicrobial stewardship [9,10]; however this approach may be unfeasible in large healthcare systems with existing EMR systems and is often reliant on structured data about antimicrobial dispensing. Within most procedural and operating room settings, pre-incisional antimicrobial prophylaxis can be directly dispensed without documentation in the EMR of medication administration.…”