scholarly journals 611Early Impact of a Pharmacist-led Antimicrobial Stewardship Program Conducted without Clinical Decision-support Software at a Community Teaching Hospital

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S29-S29
Author(s):  
Lisa Dumkow ◽  
Minerva Galang ◽  
Nnaemeka Egwuatu
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Clinical Decision ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Clinical Decision Support Software ◽  
Support Software ◽  
Community Teaching

scholarly journals Conversion of a single-facility pediatric antimicrobial stewardship program to multi-facility application with computerized provider order entry and clinical decision support

2013 ◽  
Vol 04 (04) ◽  
pp. 556-568 ◽  
Author(s):  
H.M. Warhurst ◽  
S.S. Smith ◽  
E.G. Cox ◽  
A.S. Crumby ◽  
K.R. Nichols ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Antimicrobial Stewardship ◽  
Clinical Decision ◽  
Antimicrobial Stewardship Program ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Stewardship Program ◽  
Order Sets ◽  
Single Facility

SummaryObjective: Antimicrobial stewardship programs (ASPs) help meet quality and safety goals with regard to antimicrobial use. Prior to CPOE implementation, the ASP at our pediatric tertiary hospital developed a paper-based order set containing recommendations for optimization of dosing. In adapting our ASP for CPOE, we aimed to preserve consistency in our ASP recommendations and expand ASP expertise to other hospitals in our health system.Methods: Nine hospitals in our health system adopted pediatric CPOE and share a common domain (Cerner Millenium™). ASP clinicians developed sixty individual electronic order sets (vendor reference PowerPlans™) to be used independently or as part of larger electronic order sets. Analysis of incidents reported during CPOE implementation and medication variances reports was used to determine the effectiveness of the ASP adaptation.Results: 769 unique PowerPlans™ were used 15,889 times in the first 30 days after CPOE implementation. Of these, 43 were PowerPlans™ included in the ASP design and were used a total of 1149 times (7.2% of all orders). During CPOE implementation, 437 incidents were documented, 1.1% of which were associated with ASP content or workflow. Additionally, analysis of medication variance following CPOE implementation showed that ASP errors accounted for 2.9% of total medication variances.Discussion: ASP content and workflow accounted for proportionally fewer incidents than expected as compared to equally complex and frequently used CPOE content.Conclusions: Well-defined ASP recommendations and modular design strengthened successful CPOE implementation, as well as the adoption of specialized pediatric ASP expertise with other facilities.Citation: Webber EC, Warhurst HM, Smith SS, Cox EG, Crumby AS, Nichols KR. Conversion of a single-facility pediatric antimicrobial stewardship program to multifacility application with computerized provider order entry and clinical decision support. Appl Clin Inf 2013; 4: 556–568 http://dx.doi.org/10.4338/ACI-2013-07-RA-0054

scholarly journals Examining Workflow in a Pediatric Emergency Department to Develop a Clinical Decision Support for an Antimicrobial Stewardship Program

2018 ◽  
Vol 09 (02) ◽  
pp. 248-260 ◽  
Author(s):  
Mustafa Ozkaynak ◽  
Danny Wu ◽  
Katia Hannah ◽  
Peter Dayan ◽  
Rakesh Mistry
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Antimicrobial Stewardship ◽  
Time Allocation ◽  
Care Delivery ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Design And Implementation ◽  
Decision Points ◽  
Stewardship Program

Background Clinical decision support (CDS) embedded into the electronic health record (EHR), is a potentially powerful tool for institution of antimicrobial stewardship programs (ASPs) in emergency departments (EDs). However, design and implementation of CDS systems should be informed by the existing workflow to ensure its congruence with ED practice, which is characterized by erratic workflow, intermittent computer interactions, and variable timing of antibiotic prescription. Objective This article aims to characterize ED workflow for four provider types, to guide future design and implementation of an ED-based ASP using the EHR. Methods Workflow was systematically examined in a single, tertiary-care academic children's hospital ED. Clinicians with four roles (attending, nurse practitioner, physician assistant, resident) were observed over a 3-month period using a tablet computer-based data collection tool. Structural observations were recorded by investigators, and classified using a predetermined set of activities. Clinicians were queried regarding timing of diagnosis and disposition decision points. Results A total of 23 providers were observed for 90 hours. Sixty-four different activities were captured for a total of 6,060 times. Among these activities, nine were conducted at different frequency or time allocation across four roles. Moreover, we identified differences in sequential patterns across roles. Decision points, whereby clinicians then proceeded with treatment, were identified 127 times. The most common decision points identified were: (1) after/during examining or talking to patient or relative; (2) after talking to a specialist; and (3) after diagnostic test/image was resulted and discussed with patient/family. Conclusion The design and implementation of CDS for ASP should support clinicians in various provider roles, despite having different workflow patterns. The clinicians make their decisions about treatment at different points of overall care delivery practice; likewise, the CDS should also support decisions at different points of care.

Sign in / Sign up

Export Citation Format

Share Document