Evaluating the impact of the ICNET® clinical decision support system for antimicrobial stewardship

Abstract Background Antimicrobial resistance (AMR) is an ecological and economic crisis and stewardship of available antimicrobials is required. Electronic prescribing, where available, enables auditing of practice, yet in order to be efficient and effective in addressing inappropriate antimicrobial...

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Main Authors: Katie L. Heard, Stephen Hughes, Nabeela Mughal, Berge S. Azadian, Luke S. P. Moore
Format: Article
Language:English
Published: BMC 2019-03-01
Series:Antimicrobial Resistance and Infection Control
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13756-019-0496-4
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spelling doaj-5e15035b434f4f658848fa970ba03e702020-11-25T02:58:10ZengBMCAntimicrobial Resistance and Infection Control2047-29942019-03-01811610.1186/s13756-019-0496-4Evaluating the impact of the ICNET® clinical decision support system for antimicrobial stewardshipKatie L. Heard0Stephen Hughes1Nabeela Mughal2Berge S. Azadian3Luke S. P. Moore4Chelsea and Westminster NHS Foundation TrustChelsea and Westminster NHS Foundation TrustChelsea and Westminster NHS Foundation TrustChelsea and Westminster NHS Foundation TrustChelsea and Westminster NHS Foundation TrustAbstract Background Antimicrobial resistance (AMR) is an ecological and economic crisis and stewardship of available antimicrobials is required. Electronic prescribing, where available, enables auditing of practice, yet in order to be efficient and effective in addressing inappropriate antimicrobial prescribing, better use of current and new technological interventions is needed. This retrospective observational evaluation looked at the impact of a commercial clinical decision support system (CDSS) on the workflow of an established antimicrobial stewardship (AMS) team. Material/methods Clinical, workflow, and pharmaceutical data from 3 months post implementation of CDSS were collated, and compared to the same 3 month periods in preceding years. The evaluation considered total interventions made, the types of intervention made, impact of said interventions, and time spent executing interventions. All antimicrobial data were adjusted for total daily defined doses (DDD) of intravenous antimicrobials. Results Productivity: In the 3 month evaluation period (Jun-Aug 2016) a total of 264 case reviews resulting in 298 AMS interventions were made. Compared to preceding years where 138 and 169 interventions were made (2013 and 2014 respectively). In 2013 49% of interventions were stopping medication and 30% change of therapy based on cultures and sensitivities compared to 25 and 17% in 2016. In contrast to previous years’, the CDSS instead enabled a greater number of dose/drug optimisation (13%), escalation of antimicrobials (12%) and intravenous (IV) to oral switch (11%) interventions. Patient Identification: Despite increased patient numbers post-CDSS, on average 46 min per day was spent compiling a patient list for review, compared to 59 min in 2014. The use of CDSS facilitated 15 interventions/1000DDD, compared to pre-intervention (9.4/1000DDD in 2013; 11.5/1000DDD in 2014). Conclusions Initial evaluation of the impact of this CDSS on AMS at the organisation has demonstrated effectiveness in terms of case finding, AMS team productivity, and workflow auditing. More importantly, patient infection management has been optimised with a shift in the emphasis of AMS interventions. It has contributed to the success of the healthcare provider achieving nationally set remunerated AMS targets.http://link.springer.com/article/10.1186/s13756-019-0496-4Antimicrobial resistanceAntimicrobial stewardshipClinical decision support systemeHealthmHealth
collection DOAJ
language English
format Article
sources DOAJ
author Katie L. Heard
Stephen Hughes
Nabeela Mughal
Berge S. Azadian
Luke S. P. Moore
spellingShingle Katie L. Heard
Stephen Hughes
Nabeela Mughal
Berge S. Azadian
Luke S. P. Moore
Evaluating the impact of the ICNET® clinical decision support system for antimicrobial stewardship
Antimicrobial Resistance and Infection Control
Antimicrobial resistance
Antimicrobial stewardship
Clinical decision support system
eHealth
mHealth
author_facet Katie L. Heard
Stephen Hughes
Nabeela Mughal
Berge S. Azadian
Luke S. P. Moore
author_sort Katie L. Heard
title Evaluating the impact of the ICNET® clinical decision support system for antimicrobial stewardship
title_short Evaluating the impact of the ICNET® clinical decision support system for antimicrobial stewardship
title_full Evaluating the impact of the ICNET® clinical decision support system for antimicrobial stewardship
title_fullStr Evaluating the impact of the ICNET® clinical decision support system for antimicrobial stewardship
title_full_unstemmed Evaluating the impact of the ICNET® clinical decision support system for antimicrobial stewardship
title_sort evaluating the impact of the icnet® clinical decision support system for antimicrobial stewardship
publisher BMC
series Antimicrobial Resistance and Infection Control
issn 2047-2994
publishDate 2019-03-01
description Abstract Background Antimicrobial resistance (AMR) is an ecological and economic crisis and stewardship of available antimicrobials is required. Electronic prescribing, where available, enables auditing of practice, yet in order to be efficient and effective in addressing inappropriate antimicrobial prescribing, better use of current and new technological interventions is needed. This retrospective observational evaluation looked at the impact of a commercial clinical decision support system (CDSS) on the workflow of an established antimicrobial stewardship (AMS) team. Material/methods Clinical, workflow, and pharmaceutical data from 3 months post implementation of CDSS were collated, and compared to the same 3 month periods in preceding years. The evaluation considered total interventions made, the types of intervention made, impact of said interventions, and time spent executing interventions. All antimicrobial data were adjusted for total daily defined doses (DDD) of intravenous antimicrobials. Results Productivity: In the 3 month evaluation period (Jun-Aug 2016) a total of 264 case reviews resulting in 298 AMS interventions were made. Compared to preceding years where 138 and 169 interventions were made (2013 and 2014 respectively). In 2013 49% of interventions were stopping medication and 30% change of therapy based on cultures and sensitivities compared to 25 and 17% in 2016. In contrast to previous years’, the CDSS instead enabled a greater number of dose/drug optimisation (13%), escalation of antimicrobials (12%) and intravenous (IV) to oral switch (11%) interventions. Patient Identification: Despite increased patient numbers post-CDSS, on average 46 min per day was spent compiling a patient list for review, compared to 59 min in 2014. The use of CDSS facilitated 15 interventions/1000DDD, compared to pre-intervention (9.4/1000DDD in 2013; 11.5/1000DDD in 2014). Conclusions Initial evaluation of the impact of this CDSS on AMS at the organisation has demonstrated effectiveness in terms of case finding, AMS team productivity, and workflow auditing. More importantly, patient infection management has been optimised with a shift in the emphasis of AMS interventions. It has contributed to the success of the healthcare provider achieving nationally set remunerated AMS targets.
topic Antimicrobial resistance
Antimicrobial stewardship
Clinical decision support system
eHealth
mHealth
url http://link.springer.com/article/10.1186/s13756-019-0496-4
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