A Computer-Assisted Management Program for Antibiotics and Other Antiinfective Agents

Abstract

During the intervention period, all 545 patients admitted were cared for with the aid of the antiinfectives-management program. Measures of processes and outcomes were compared with those for the 1136 patients admitted to the same unit during the two years before the intervention period. The use of the program led to significant reductions in orders for drugs to which the patients had reported allergies (35, vs. 146 during the preintervention period; P<0.01), excess drug dosages (87 vs. 405, P<0.01), and antibiotic-susceptibility mismatches (12 vs. 206, P<0.01). There were also marked reductions in the mean number of days of excessive drug dosage (2.7 vs. 5.9, P<0.002) and in adverse events caused by antiinfective agents (4 vs. 28, P<0.02). In analyses of patients who received antiinfective agents, those treated during the intervention period who always received the regimens recommended by the computer program (n=203) had significant reductions, as compared with those who did not always receive the recommended regimens (n= 195) and those in the preintervention cohort (n = 766), in the cost of antiinfective agents (adjusted mean, $102 vs. $427 and $340, respectively; P<0.001), in total hospital costs (adjusted mean, $26,315 vs. $44,865 and $35,283; P<0.001), and in the length of the hospital stay days (adjusted mean, 10.0 vs. 16.7 and 12.9; P<0.001). CONCLUSIONS; A computerized antiinfectives-management program can improve the quality of patient care and reduce costs.

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

“…85 CDSSs can take many forms, including comprehensive computerized disease management systems that can integrate clinical data, medication orders, and laboratory and microbiology results to suggest anti-infective therapy and alert clinicians about potential suboptimal management of infections. [86][87][88][89] Several studies of rapid blood culture diagnostics report favorable outcomes when rapid test results are reported together with CDSSs that provide actionable guidance for clinicians through antimicrobial stewardship team oversight [90][91][92][93][94][95][96][97] or even templated comments contained within the result report. 84 Increasingly, electronic health records platforms such as Epic and Cerner are incorporating CDSSs to enhance antimicrobial stewardship.…”

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

“…46 Evans et al examined computer-assisted management of antibiotic choices in ICU patients. 47 A combination of computer order entry and assisted decision making reduced overall adverse events secondary to drugs ordered, including instances in which a patient received a drug known to have precipitated an allergic reaction in the past. The combination of online medical records, up-to-date pharmaceutical recommendations, and use of the most immediately available patient information makes this system a model for what is possible with computer-based drug ordering.…”

Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia

“…Evans and colleagues described a CDSS to help with the appropriate selection of antibiotics. While this tool improved antibiotic decision-making, one important finding was that the recommendations were not followed automatically [34].…”