Using information systems technology to improve antibiotic prescribing

Abstract

The selection of antimicrobial agents in the hospital setting is still a largely manual task and, therefore, fraught with the potential for error. This includes the choice of agents, dosage regimens, and monitoring for response and toxicity. The authors describe current and future strategies to use information technology to improve the process of antimicrobial selection and to avoid dosing errors and contraindicated drug combinations. The possible role of decision support in preventing the emergence of resistance is also discussed.

Guidelines for Therapeutic Interchange—2004

“…When applied to the setting of drug prescriptions, they have the potential to alter physician prescribing practices substantially. 15,16 The greatest advantages to computerized physician order entry lie in the ability of the system to offer only those drugs listed on the institution' s or health care system' s formulary, or to highlight those preferred drugs approved by the pharmacy and therapeutics committee for therapeutic interchange. Guidelines for drug use, and the rationale for substitution, can be displayed in real time at the critical point of physician initiation.…”

“…There are many studies documenting increases in therapeutic interchange policy adherence through the use of computerized physician order entry. [15][16][17][18][19] Statistically significant increases in use of formulary drugs and statistically significant decreases in orders exceeding the maximum recommended dose have been demonstrated. 15 However, there must always be a process by which a prescriber may override a therapeutic interchange recommendation built into the computerized physician order entry system.…”

“…Computerized physician order entry would provide immediate notification of specific therapeutic interchanges and may serve as a constant reminder that such policies exist. 16,19 Patient disclosure and educational materials may be developed in written or audiovisual format as appropriate to introduce the concept of therapeutic interchange, address the potential impact to their care, and promote drug adherence. Managed care plans must prospectively notify or disclose to enrollees information regarding the policies and limitations or restrictions on the benefits package (which should include prescription coverage and policies of therapeutic interchange).…”

Drug use evaluation of cefepime in the first affiliated hospital of Bengbu medical college: a retrospective and prospective analysis

“…To strengthen safety supervision, adjustments were given by us to them, including: first, increasing the observation and treatment of rare adverse reactions (such as toxic nephrosis and renal dysfunction), while emphasizing the detection and specific treatment measures for different types of adverse reactions; second, promoting clinical experience to prevent the possibility of adverse reactions occurring (such as the use of antibiotics in patients along with the timely use of intestinal microecological preparations, according to the drug instructions) [16]. The reasons for adding these items are that: 1. the ADR reporting system should be made more efficient to minimize the incidence of adverse effects during the therapy; 2. in our healthcare setup, the majority of the ADRs are unnoticed; 3. patients should be given sufficient information regarding their medicines so that they can identify any abnormal finding in their course of therapy [21,22]; 4. the effectiveness of cefepime therapy can be enhanced and the adverse effects can be avoided to some extent by more vigilant and positive attitudes among prescribers, nurses and pharmacists. This requires a more collaborative practice among physicians and pharmacists so that pharmacists can guide physicians to the rational prescription and safer use of medicines.…”

Information technology for optimizing the management of infectious diseases

“…13 Primary reasons for this high cost include the need to collect relevant data from multiple systems that do not communicate with each other, the use of nonstandard terminologies in existing information systems, and the need for substantial user training. 13,55,56 Thus, fully functional, integrated systems remain unattainable at present for many hospitals. 57 In 2002, only 9.6% of U.S. hospitals had implemented CPOE systems, 58 and less than 10% of U.S. health care providers currently use EMRs.…”