The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing

Abstract

Background To describe and evaluate a clinical decision support system (CDSS) for empirical antibiotic therapy using a systematic framework. Methods A reporting framework for behavior change intervention implementation was used, which includes several domains: development, evaluation and implementation. Within the development domain a description is given of the engagement of stakeholders, a rationale for how the CDSS may influence antibiotic prescribing and a detailed outline of how the system was developed. Within the evaluation domain a technical validation is performed and the interaction between potential users and the CDSS is analyzed. Within the domain of implementation a description is given on how the CDSS was tested in the real world and the strategies that were used for implementation and adoption of the CDSS. Results Development: a CDSS was developed, with the involvement of stakeholders, to assist empirical antibiotic prescribing by physicians. Evaluation: Technical problems were determined during the validation process and corrected in a new CDSS version. A usability study was performed to assess problems in the system-user interaction. Implementation: In 114 patients the antibiotic advice that was generated by the CDSS was followed. For 54 patients the recommendations were not adhered to. Conclusions This study describes the development and validation of a CDSS for empirical antibiotic therapy and shows the usefulness of the systematic framework for reporting CDSS interventions. In addition it shows that CDSS recommendations are not always adhered to which is associated with incorrect use of the system.

Achieving universal health coverage in low- and middle-income countries through digital antimicrobial stewardship

“…Digitalization can also enhance AMS processes and help overcome challenges associated with implementing these processes (23). For example, clinical decision support systems (CDSS) can aid physicians in correctly diagnosing bacterial infections and guiding the choice of empiric antibiotic therapy (37)(38)(39)(40). By combining a patient's bio-data, clinical history and diagnostic results (i.e., laboratory and radiological) CDSS can facilitate improved clinical decision-making, optimized antimicrobial therapy and better treatment outcomes (37)(38)(39)(40).…”

Decision Challenges for Managing Acute Paediatric Infections: Implications for Antimicrobial Resistance

“…Carefully designed decision tools not only provide prescribers with more detailed information, but also have the additional potential to reduce intuitive or heuristic decision making and thereby decrease the harmful influence of cognitive biases. Indeed, previous trials of computerised decision support systems have shown such tools' potential to improve clinical decision making, although adherence to the system's recommendations and correct system use are likely to be prerequisites [34].…”