Real-Time Computerized Stewardship Advice Promotes Judicious Antimicrobial Use


During a year-long study, 80 electronic conversational comments were made using the stewardship team’s audit-and-feedback tool and recommendations were fully adopted 90% of the time.

Antimicrobial stewardship programs rely on effective and timely communication from prescribers in order to be successful in hospital settings. However, this process may become easier in the future as recent developments in technology have led to the development and implementation of computerized prescribing order entries and alert-based clinical decision support systems.

Investigators from Western University, London Health Sciences Centre in London, Canada, conducted a study to evaluate these systems by implementing them for “audit-and-feedback” interventions in a large tertiary care medical center.

The findings of the study were presented in a late breaking poster at the European Congress for Clinical Microbiology and Infectious Diseases (ECCMID 2019).

For the study, the antimicrobial stewardship team at London Health Sciences Centre implemented a new tool for audit-and-feedback interventions which used an Information Technology-developed multi-phasic conversational alert-based computerized prescribing order entry-based tool. The tool allowed for remote and/or complex prospective audit-and-feedback on patients that were admitted to receive medicine, medicine subspecialty, critical care, and surgical services from January 1, 2018 to December 31, 2018.

Through this program, alters were generated each time a patient’s electronic health record was accessed to view text-based orders, patient outcomes, or provisional prescriptions. The alerts were generated until they were acknowledged by the admitting clinicians. The investigators assessed the rate of acknowledgment and the full adoption of the recommendations during the study period.

Throughout the year-long study, a total of 80 electronic conversational recommendations were made using the antimicrobial stewardship team’s audit-and-feedback tool. Assessments found that all 80 recommendations were acknowledged by the responsible admitting clinician.

From the total 80 electronic conversational recommendations, 51 involved advice to modify the dose of an antimicrobial or de-escalate therapy, 25 recommendations suggested a consultation by an Infectious Diseases clinician, 3 recommendations by the stewardship team called for the escalation of therapy, and 1 involved a recommendation for diagnostic testing.

Overall, the recommendations by the stewardship team were fully adopted in 72 of the 80 total recommendations (90%), partial adoption of recommendations were observed in 2 cases (2.5%), and recommendations were not adopted at all in 6/80 (7.5%) of cases.

“Our multi-phasic CPOE-based alert tool for communicating recommended stewardship interventions proved to be effective in supporting judicious antimicrobial use,” the investigators write in their abstract, noting that education of prescribers could increase the utility and effectiveness of this strategy.

The study, “Implementation and Effectiveness of a Real-Time Computerized Physician Order Entry Conversational Tool for Antimicrobial Stewardship Interventions,” was presented in a late breaker oral abstract session on April 16, 2019, at ECCMID 2019 in Amsterdam, the Netherlands.

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