ArticleApplied clinical informatics2017
Redesign of computerized decision support to improve antimicrobial prescribing. A controlled before-and-after study.
Article in Applied clinical informatics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 4 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis.BMJ quality & safety · 2023Pooled it
- Factors influencing the implementation of decision support systems for antibiotic prescription in hospitals: a systematic review.BMC medical informatics and decision making · 2023Pooled it
- Stakeholder Perspectives of Clinical Artificial Intelligence Implementation: Systematic Review of Qualitative Evidence.Journal of medical Internet research · 2023Pooled it
- How do stakeholders experience the adoption of electronic prescribing systems in hospitals? A systematic review and thematic synthesis of qualitative studies.BMJ quality & safety · 2019Pooled it
- Compulsory Indications in Hospital Prescribing Software Tested with Antibacterial Prescriptions.AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science · 2024Article
- Determination of the Enablers and Challenges in the Implementation of Pharmacy-based Antimicrobial Stewardship (AMS) Program in a Level 3 Hospital in Manila.Acta medica Philippina · 2024Article
- ePrescribing-Based Antimicrobial Stewardship Practices in an English National Health Service Hospital: Qualitative Interview Study Among Medical Prescribers and Pharmacists.JMIR formative research · 2023Article
- Digital interventions for antimicrobial prescribing and monitoring: a qualitative meta-synthesis of factors influencing user acceptance.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures.JAC-antimicrobial resistance · 2022Article
- Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review.Journal of medical Internet research · 2022Article
- Article
- The safety of computerised prescribing in hospitals.Australian prescriber · 2019Review
- Comparison of Antibiotic Dosing Before and After Implementation of an Electronic Order Set.Applied clinical informatics · 2019Article
- Examining Workflow in a Pediatric Emergency Department to Develop a Clinical Decision Support for an Antimicrobial Stewardship Program.Applied clinical informatics · 2018Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the impact of the introduction of new pre-written orders for antimicrobials in a computerized provider order entry (CPOE) system on 1) accuracy of documented indications for antimicrobials in the CPOE system, 2) appropriateness of antimicrobial prescribing, and 3) compliance with the hospital's antimicrobial policy. Prescriber opinions of the new decision support were also explored to determine why the redesign was effective or ineffective in altering prescribing practices.
methodsThe study comprised two parts: a controlled pre-post study and qualitative interviews. The intervention involved the redesign of pre-written orders for half the antimicrobials so that approved indications were incorporated into pre-written orders. 555 antimicrobials prescribed before (September - October, 2013) and 534 antimicrobials prescribed after (March - April, 2015) the intervention on all general wards of a hospital were audited by study pharmacists. Eleven prescribers participated in semi-structured interviews.
resultsRedesign of computerized decision support did not result in more appropriate or compliant antimicrobial prescribing, nor did it improve accuracy of indication documentation in the CPOE system (Intervention antimicrobials: appropriateness 49% vs. 50%; compliance 44% vs. 42%; accuracy 58% vs. 38%; all p>0.05). Via our interviews with prescribers we identified five main reasons for this, primarily that indications entered into the CPOE system were not monitored or followed-up, and that the antimicrobial approval process did not align well with prescriber workflow.
conclusionRedesign of pre-written orders to incorporate appropriate indications did not improve antimicrobial prescribing. Workarounds are likely when compliance with hospital policy creates additional work for prescribers or when system usability is poor. Implementation of IT, in the absence of support or follow-up, is unlikely to achieve all anticipated benefits.
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