Clinical decision support tools to improve quality and practice efficiency across a large network of oncology practices.

294 Background: Electronic health records (EHR) provide opportunities for quality enhancements at various points in care. It can support electronic orders, meaningful use, progress notes, medication and allergy data, electronic prescribing, and vital-signs tracking. Clinical decision support tools (CDST) can facilitate high-quality performance and practice efficiency. These enhancements reduce error, improve quality, and drive practice efficiency. The oncology specific EHR (IKnowMed) incorporates CDST including physician driven level 1 pathways prescribing, chemotherapy regimen order entry, dose calculation, supportive care drugs, and guidelines for safe prescribing. Methods: To understand scope and utilization of CDSTs within a large network of individual oncology practices we characterized (qualitatively and quantitatively) common modalities in our EHR (iKnowMed). Treatment regimens were populated by the network collaborative-care committee. Physicians selected regimens pre-populated w/doses and pre-medications. Antiemetic regimens were pre-populated for emetagenic potential of the chemotherapy regimen. Results: Across the US Oncology Network, 952 physicians used the EHR to deliver services over a 5-month period. During that time, 69,448 cancer treatment regimens were ordered, pre-populated by drug, dose and pre-medications; and 68,268 chemotherapy regimens were pre-populated with antiemetic therapy to mirror emetagenic potential. Conclusions: By enhancing the EHR to include CDSTs, treatment and appropriate antiemetic regimens can be pre-populated across a large network of individual oncology practices that have aligned together using common IT and CDST to drive quality care for their patients. The network is using technology to enhance quality and efficiency in practice.

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72. Improving Antibiotic Prescribing in Interventional Radiology Using Clinical Decision Support Tools to Assess Penicillin Allergies

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.117 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S54-S54

Author(s):

Vidya Atluri ◽

Paula Marsland ◽

Luke M Johnson ◽

Rupali Jain ◽

Paul Pottinger ◽

...

Keyword(s):

Interventional Radiology ◽

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision ◽

Prophylactic Antibiotics ◽

Decision Support Tools ◽

First Line ◽

Support Tools ◽

History Of ◽

Clinical Decision Support Tools

Abstract Background Patients labeled with penicillin allergies often receive alternative antibiotics, leading to increased cost, higher risk of adverse events, and decreased efficacy of procedural prophylaxis. However, most of those patients can tolerate a cephalosporin. University of Washington Medical Center – Montlake (UWMC-ML) Interventional Radiology (IR) frequently administer a pre-procedure prophylactic cephalosporin. We worked with the clinicians in IR to develop tools to allow them to better assess penicillin allergies, make the most appropriate antibiotic choice, and update the patient’s allergy documentation. Methods We identified all patients who underwent procedures in IR between 2017–2019. Chart review was done to determine the procedures performed, patient demographic information, allergies, allergy documentation, and prophylactic antibiotics received. In May 2020 we implemented new Clinical Decision Support tools, including an online assessment app (https://tinyurl.com/IRPCNAllAssess) and handouts to guide antibiotic decision making to clinicians in IR. Results From 2017 to 2019, 381 patients underwent 958 procedures in IR. Of those, 379 patients underwent 496 procedures for which the recommended first line choice for antibiotic prophylaxis is a cephalosporin. Of patients who received pre-procedure prophylactic antibiotics for those procedures, 15.9% [n=11] of patients with penicillin allergies received the first line antibiotic, compared to 89.9% [n=319] of patients without a reported penicillin allergy. Since implementation, the online app has been used to evaluate 9 patients, of whom 8 had penicillin allergies. All 8 patients safely received the first line antibiotic (3 were delabeled, 4 reported a history of mild reactions, and 1 reported a history of an immediate IgE mediated response to penicillin but safely received cefazolin). Conclusion IR evaluates hundreds of patients who may receive prophylactic antibiotics each year. By providing tools to assess penicillin allergies, we were able to improve both their prescribing and de-label patients which will provide a much broader impact on their care than on just their current procedure. Our free tool can be accessed at the website above, and we will demonstrate in person. Disclosures All Authors: No reported disclosures

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