TY - JOUR
T1 - Developing clinical decision support within a commercial electronic health record system to improve antimicrobial prescribing in the neonatal ICU
AU - Hum, R. S.
AU - Cato, K.
AU - Sheehan, B.
AU - Patel, S.
AU - Duchon, J.
AU - DeLaMora, P.
AU - Ferng, Y. H.
AU - Graham, P.
AU - Vawdrey, D. K.
AU - Perlman, J.
AU - Larson, E.
AU - Saiman, L.
PY - 2014
Y1 - 2014
N2 - Objective: To develop and implement a clinical decision support (CDS) tool to improve antibiotic prescribing in neonatal intensive care units (NICUs) and to evaluate user acceptance of the CDS tool. Methods: Following sociotechnical analysis of NICU prescribing processes, a CDS tool for empiric and targeted antimicrobial therapy for healthcare-associated infections (HAIs) was developed and incorporated into a commercial electronic health record (EHR) in two NICUs. User logs were reviewed and NICU prescribers were surveyed for their perceptions of the CDS tool. Results: The CDS tool aggregated selected laboratory results, including culture results, to make treatment recommendations for common clinical scenarios. From July 2010 to May 2012, 1,303 CDS activations for 452 patients occurred representing 22% of patients prescribed antibiotics during this period. While NICU clinicians viewed two culture results per tool activation, prescribing recommendations were viewed during only 15% of activations. Most (63%) survey respondents were aware of the CDS tool, but fewer (37%) used it during their most recent NICU rotation. Respondents considered the most useful features to be summarized culture results (43%) and antibiotic recommendations (48%). Discussion: During the study period, the CDS tool functionality was hindered by EHR upgrades, implementation of a new laboratory information system, and changes to antimicrobial testing methodologies. Loss of functionality may have reduced viewing antibiotic recommendations. In contrast, viewing culture results was frequently performed, likely because this feature was perceived as useful and functionality was preserved. Conclusion: To improve CDS tool visibility and usefulness, we recommend early user and information technology team involvement which would facilitate use and mitigate implementation challenges.
AB - Objective: To develop and implement a clinical decision support (CDS) tool to improve antibiotic prescribing in neonatal intensive care units (NICUs) and to evaluate user acceptance of the CDS tool. Methods: Following sociotechnical analysis of NICU prescribing processes, a CDS tool for empiric and targeted antimicrobial therapy for healthcare-associated infections (HAIs) was developed and incorporated into a commercial electronic health record (EHR) in two NICUs. User logs were reviewed and NICU prescribers were surveyed for their perceptions of the CDS tool. Results: The CDS tool aggregated selected laboratory results, including culture results, to make treatment recommendations for common clinical scenarios. From July 2010 to May 2012, 1,303 CDS activations for 452 patients occurred representing 22% of patients prescribed antibiotics during this period. While NICU clinicians viewed two culture results per tool activation, prescribing recommendations were viewed during only 15% of activations. Most (63%) survey respondents were aware of the CDS tool, but fewer (37%) used it during their most recent NICU rotation. Respondents considered the most useful features to be summarized culture results (43%) and antibiotic recommendations (48%). Discussion: During the study period, the CDS tool functionality was hindered by EHR upgrades, implementation of a new laboratory information system, and changes to antimicrobial testing methodologies. Loss of functionality may have reduced viewing antibiotic recommendations. In contrast, viewing culture results was frequently performed, likely because this feature was perceived as useful and functionality was preserved. Conclusion: To improve CDS tool visibility and usefulness, we recommend early user and information technology team involvement which would facilitate use and mitigate implementation challenges.
KW - Antimicrobial stewardship
KW - Clinical decision support
KW - Implementation
KW - Neonatal intensive care unit
UR - http://www.scopus.com/inward/record.url?scp=84904108580&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84904108580&partnerID=8YFLogxK
U2 - 10.4338/ACI-2013-09-RA-0069
DO - 10.4338/ACI-2013-09-RA-0069
M3 - Article
C2 - 25024755
AN - SCOPUS:84904108580
SN - 1869-0327
VL - 5
SP - 368
EP - 387
JO - Applied Clinical Informatics
JF - Applied Clinical Informatics
IS - 2
ER -