Appl Clin Inform 2013; 04(04): 556-568
DOI: 10.4338/ACI-2013-07-RA-0054
Research Article
Schattauer GmbH

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

E.C. Webber
1   Indiana University School of Medicine, Pediatrics, Indianapolis, Indiana, United States
,
H.M. Warhurst
2   Riley Hospital for Children at IU Health, Clinical Pharmacy, Indianapolis, Indiana, United States
,
S.S. Smith
3   Indiana University Health, Pharmacy Clinical Informatics, Indianapolis, Indiana, United States
,
E.G. Cox
1   Indiana University School of Medicine, Pediatrics, Indianapolis, Indiana, United States
,
A.S. Crumby
2   Riley Hospital for Children at IU Health, Clinical Pharmacy, Indianapolis, Indiana, United States
,
K.R. Nichols
2   Riley Hospital for Children at IU Health, Clinical Pharmacy, Indianapolis, Indiana, United States
› Author Affiliations
Further Information

Correspondence to:

Emily Webber MD, FAAP
705 Riley Hospital Drive
Indianapolis, IN 46220
United States

Publication History

Received: 21 August 2013

Accepted: 23 October 2013

Publication Date:
19 December 2017 (online)

 

Summary

Objective: 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


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Conflicts of interest

The authors declare that they have no conflicts of interest in the research.

  • References

  • 1 Newland JG and AL Hersh.. Purpose and design of antimicrobial stewardship programs in pediatrics. Pediatr Infect Dis J 2010; 29: 862-863.
  • 2 Di Pentima MC, Chan S, Eppes SC, Klein JD. Antimicrobial prescription errors hospitalized children: role of antimicrobial stewardship program in detection and intervention. Clin Pediatr 2009; 48: 505-512.
  • 3 Metjian TA, Prasad PA, Kogon A, Coffin SE, Zaoutis TE. Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital. Pediatr Infect Dis J 2008; 27: 106-111.
  • 4 Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years?. Infect Control Hosp Epidemiol 2003; 24: 699-706.
  • 5 Hersh AL, Beekmann SE, Polgreen PM, Zaoutis TE, Newland JG. Antimicrobial stewardship programs in pediatrics. Infect Control Hosp Epidemiol. 2009; 30 (12) 1211-1217.
  • 6 Johannsson B, Beekmann SE, Srinivasan A, Hersh AL, Laxminaravan R, Polgreen PM. Improving antimicrobial stewardship: the evolution of programmatic strategies and barriers. Infect Control Hosp Epidemiol 2011; 32 (Suppl. 04) 367-374.
  • 7 Sunenshine RH, Liedtke LA, Jernigan DB, Strausbaugh LG. Role of infectious diseases consultants in management of antimicrobial use in hospitals. Clin Infect Dis 2004; 38 (Suppl. 07) 934-938.
  • 8 The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).. Accessed on September 11 2013 http://www.nccmerp.org
  • 9 Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE, Townsend T, Lehmann CU. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis 2008; 47 (Suppl. 06) 747-753.
  • 10 Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme Jr JF, Lloyd JF, Burke JP. A computer assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998; 338: 232-238.
  • 11 Linder JA, Bates DW, Williams DH, Connolly MA, Middleton B. Acute infections in primary care: accuracy of electronic diagnoses and electronic antibiotic prescribing. J Am Med Inform Assoc 2006; 13: 61-66.
  • 12 Mainous 3rd AG, Lambourne CA, Nietert PJ. Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial. J Am Med Inform Assoc 2013; 20: 317-324.
  • 13 Pestotnik SL, Classen DC, Evans RS, Burke JP. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996; 124: 884-890.
  • 14 McGregor JC, Weekes E, Forrest GN, Standiford HC, Perencevich EN, Furuno JP, Harris GD. Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized control trial. J Am Med Inform Assoc 2006; 13: 378-384.
  • 15 Sáez-Llorens X, Castrejón de Wong MM, Castaño E, De Suman O, De Morös D, De Atencio I. Impact of an antibiotic restriction policy on hospital expenditures and bacterial susceptibilities: a lesson from a pediatric institution in a developing country. Pediatr Infect Dis J 2000; 19 (Suppl. 03) 200-206.
  • 16 Ozkurt Z, Erol S, Kadanali A, Ertek M, Ozden K, Tasyaran MA. Changes in antibiotic use, cost and consumption after an antibiotic restriction policy applied by infectious disease specialists. Jpn J Infect Dis 2005; 58 (Suppl. 06) 338-343.
  • 17 Sick AC, Lehmann CU, Tamma PD, Lee CK, Al Agwu. Sustained savings from a longitudinal cost analysis of an internet-based preapproval antimicrobial stewardship program. Infect Control Hosp Epidemiol 2013; 34 (Suppl. 06) 573-580.
  • 18 Wright A, Sittig DF, Ash JS, Feblowitz J, Meltzer S, McMullen C, Guappone K, Carpenter J, Richardson J, Simonaitis L, Evans RS, Nichol WP, Middleton B. “Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems. J Am Med Inform Assoc 2011; 18: 232-242.
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Correspondence to:

Emily Webber MD, FAAP
705 Riley Hospital Drive
Indianapolis, IN 46220
United States

  • References

  • 1 Newland JG and AL Hersh.. Purpose and design of antimicrobial stewardship programs in pediatrics. Pediatr Infect Dis J 2010; 29: 862-863.
  • 2 Di Pentima MC, Chan S, Eppes SC, Klein JD. Antimicrobial prescription errors hospitalized children: role of antimicrobial stewardship program in detection and intervention. Clin Pediatr 2009; 48: 505-512.
  • 3 Metjian TA, Prasad PA, Kogon A, Coffin SE, Zaoutis TE. Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital. Pediatr Infect Dis J 2008; 27: 106-111.
  • 4 Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years?. Infect Control Hosp Epidemiol 2003; 24: 699-706.
  • 5 Hersh AL, Beekmann SE, Polgreen PM, Zaoutis TE, Newland JG. Antimicrobial stewardship programs in pediatrics. Infect Control Hosp Epidemiol. 2009; 30 (12) 1211-1217.
  • 6 Johannsson B, Beekmann SE, Srinivasan A, Hersh AL, Laxminaravan R, Polgreen PM. Improving antimicrobial stewardship: the evolution of programmatic strategies and barriers. Infect Control Hosp Epidemiol 2011; 32 (Suppl. 04) 367-374.
  • 7 Sunenshine RH, Liedtke LA, Jernigan DB, Strausbaugh LG. Role of infectious diseases consultants in management of antimicrobial use in hospitals. Clin Infect Dis 2004; 38 (Suppl. 07) 934-938.
  • 8 The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).. Accessed on September 11 2013 http://www.nccmerp.org
  • 9 Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE, Townsend T, Lehmann CU. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis 2008; 47 (Suppl. 06) 747-753.
  • 10 Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme Jr JF, Lloyd JF, Burke JP. A computer assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998; 338: 232-238.
  • 11 Linder JA, Bates DW, Williams DH, Connolly MA, Middleton B. Acute infections in primary care: accuracy of electronic diagnoses and electronic antibiotic prescribing. J Am Med Inform Assoc 2006; 13: 61-66.
  • 12 Mainous 3rd AG, Lambourne CA, Nietert PJ. Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial. J Am Med Inform Assoc 2013; 20: 317-324.
  • 13 Pestotnik SL, Classen DC, Evans RS, Burke JP. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996; 124: 884-890.
  • 14 McGregor JC, Weekes E, Forrest GN, Standiford HC, Perencevich EN, Furuno JP, Harris GD. Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized control trial. J Am Med Inform Assoc 2006; 13: 378-384.
  • 15 Sáez-Llorens X, Castrejón de Wong MM, Castaño E, De Suman O, De Morös D, De Atencio I. Impact of an antibiotic restriction policy on hospital expenditures and bacterial susceptibilities: a lesson from a pediatric institution in a developing country. Pediatr Infect Dis J 2000; 19 (Suppl. 03) 200-206.
  • 16 Ozkurt Z, Erol S, Kadanali A, Ertek M, Ozden K, Tasyaran MA. Changes in antibiotic use, cost and consumption after an antibiotic restriction policy applied by infectious disease specialists. Jpn J Infect Dis 2005; 58 (Suppl. 06) 338-343.
  • 17 Sick AC, Lehmann CU, Tamma PD, Lee CK, Al Agwu. Sustained savings from a longitudinal cost analysis of an internet-based preapproval antimicrobial stewardship program. Infect Control Hosp Epidemiol 2013; 34 (Suppl. 06) 573-580.
  • 18 Wright A, Sittig DF, Ash JS, Feblowitz J, Meltzer S, McMullen C, Guappone K, Carpenter J, Richardson J, Simonaitis L, Evans RS, Nichol WP, Middleton B. “Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems. J Am Med Inform Assoc 2011; 18: 232-242.
  • 19 Hermsen ED, VanSchooneveld TC, Sayles H, Rupp ME. Implementation of a clinical decision support system for antimicrobial stewardship. Infect Control Hosp Epidemiol 2012; 33: 412-414.
  • 20 Dellit TH, Owens RC, McGowan Jr JE, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007; 15 44 (Suppl. 02) 159-177.
  • 21 Thursky K. Use of computerized decision support systems to improve antibiotic prescribing. Expert Rev Anti Infect Ther 2006; 4: 491-507.