A Computer-Assisted Prescription System to Improve Antibacterial Surgical Prophylaxis

Rodrigues, Joana; Casado, André; Palos, Carlos; Santos, Cláudia; Duarte, Aida; Fernández-Llimós, Fernando

doi:10.1086/664923

Cited by 8 publications

(4 citation statements)

References 6 publications

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“…We found that most work has been conducted in relation to CPOE and CDS systems, focusing on interventions that targeted individual prescribers through prompts and reminders …”

Section: Resultsmentioning

confidence: 99%

“…In relation to practitioner performance, the studies reported improved turnaround time for first dose of antibiotic, improved selection of antibiotics (e.g. in line with local protocols), optimal dosing, improved adherence to guidelines/protocols, and a decrease in the total number of antibiotics prescribed . Some studies also reported a reduction in prescribing errors and increased de‐escalation, as well as improved antibiotic sensitivity and increase in sensitivity of surgical site infection detection .…”

Section: Resultsmentioning

confidence: 99%

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Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

et al. 2016

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Objective To identify approaches of using stand-alone and more integrated hospital ePrescribing systems to promote and support the appropriate use of antibiotics, and identify gaps in order to inform future efforts in this area. Methods A systematic scoping review of the empirical literature from 1997 until 2015, searching the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Trials, International Standard Randomised Controlled Trial Number Registry, Economic Evaluation database and International Prospective Register of Systematic Reviews. Search terms related to different components of systems, hospital settings and antimicrobial stewardship. Two reviewers independently screened papers and mutually agreed papers for inclusion. We undertook an interpretive synthesis. Key findings We identified 143 papers. The majority of these were single-centre observational studies from North American settings with a wide range of system functionalities. Most evidence related to computerised decision support (CDS) and computerised physician order entry (CPOE) functionalities, of which many were extensively customised. We also found some limited work surrounding integration with laboratory results, pharmacy systems and organisational surveillance. Outcomes examined included healthcare professional performance, patient outcomes and health economic evaluations. We found at times conflicting conclusions surrounding effectiveness, which may be due to heterogeneity of populations, technologies and outcomes studied. Reports of unintended consequences were limited. Conclusions Interventions are centred on CPOE and CDS, but also include additional functionality aiming to support various facets of the medicines management process. Wider organisational dimensions appear important to supporting adoption. Evaluations should consider processes, clinical, economic and safety outcomes in order to generate generalisable insights into safety, effectiveness and cost-effectiveness.

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“…We found that most work has been conducted in relation to CPOE and CDS systems, focusing on interventions that targeted individual prescribers through prompts and reminders …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

et al. 2016

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“…CDSSs to support appropriate use of antibiotics target a variety of aspects, such as optimizing antimicrobial dosing [17–19] or supporting antimicrobial de-escalation [20, 21]. Most of these systems however focus on antimicrobial prescribing [15, 22, 23]. It has been shown that CDSS can increase confidence of general practitioners in their antibiotic prescriptions [24].…”

Section: Introductionmentioning

confidence: 99%

A usability study to improve a clinical decision support system for the prescription of antibiotic drugs

et al. 2019

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ObjectiveA clinical decision support system (CDSS) for empirical antibiotic treatment has the potential to increase appropriate antibiotic use. Before using such a system on a broad scale, it needs to be tailored to the users preferred way of working. We have developed a CDSS for empirical antibiotic treatment in hospitalized adult patients. Here we determined in a usability study if the developed CDSS needed changes.MethodsFour prespecified patient cases, based on real life clinical scenarios, were evaluated by 8 medical residents in the study. The “think-aloud” method was used, and sessions were recorded and analyzed afterwards. Usability was assessed by 3 evaluators using an augmented classification scheme, which combines the User Action Framework with severity rating of the usability problems and the assessment of the potential impact of these problems on the final task outcomes.ResultsIn total 51 usability problems were identified, which could be grouped into 29 different categories. Most (n = 17/29) of the usability problems were cosmetic problems or minor problems. Eighteen (out of 29) of the usability categories could have an ordering error as a result. Classification of the problems showed that some of the problems would get a low priority based on their severity rating, but got a high priority for their impact on the task outcome. This effectively provided information to prioritize system redesign efforts.ConclusionUsability studies improve lay-out and functionality of a CDSS for empirical antibiotic treatment, even after development by a multidisciplinary system.

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“…Further, a special-topic issue of Infection Control and Hospital Epidemiology on antimicrobial stewardship included 15 articles that evaluated cost, utilization, or clinical outcomes. Of these, 8 articles focused solely on antimicrobial costs and/or utilization [37,41,44,46,50,56,58,59]. Overall, antimicrobial utilization/ costs was the only or the primary outcome in 80% (12/15) of the manuscripts published in this special issue, demonstrating the preponderant emphasis on these particular metrics.…”

Section: Antimicrobial Utilization and Costsmentioning

confidence: 99%

Antimicrobial Stewardship: Philosophy Versus Practice

Ashley¹,

Kaye²,

DePestel³

et al. 2014

Clinical Infectious Diseases

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To promote the judicious use of antimicrobials and preserve their usefulness in the setting of growing resistance, a number of policy-making bodies and professional societies have advocated the development of antimicrobial stewardship programs. Although these programs have been implemented at many institutions in the United States, their impact has been difficult to measure. Current recommendations advocate the use of both outcome and process measures as metrics for antimicrobial stewardship. Although patient outcome metrics have the greatest impact on the quality of care, the literature shows that antimicrobial use and costs are the indicators measured most frequently by institutions to justify the effectiveness of antimicrobial stewardship programs. The measurement of more meaningful outcomes has been constrained by difficulties inherent to these measures, lack of funding and resources, and inadequate study designs. Antimicrobial stewardship can be made more credible by refocusing the antimicrobial review process to target specific disease states, reassessing the usefulness of current metrics, and integrating antimicrobial stewardship program initiatives into institutional quality and safety efforts.

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A Computer-Assisted Prescription System to Improve Antibacterial Surgical Prophylaxis

Cited by 8 publications

References 6 publications

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

A usability study to improve a clinical decision support system for the prescription of antibiotic drugs

Antimicrobial Stewardship: Philosophy Versus Practice

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