Conversion of a single-facility pediatric antimicrobial stewardship program to multi-facility application with computerized provider order entry and clinical decision support
| Autor: | Kristen R. Nichols, Elaine G. Cox, Emily C. Webber, H. M. Warhurst, A. S. Crumby, S. S. Smith |
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| Rok vydání: | 2013 |
| Předmět: |
0301 basic medicine
Knowledge management Quality Assurance Health Care Vendor 030106 microbiology Health Informatics Pharmacists Pediatrics Clinical decision support system Medical Order Entry Systems Order entry 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents Health Information Management Physicians Humans Medication Errors Medicine Antimicrobial stewardship Operations management 030212 general & internal medicine Child Tertiary Healthcare business.industry Variance (accounting) Decision Support Systems Clinical Hospitals Computer Science Applications Workflow Antimicrobial use Health Facilities business Research Article Order set |
| Zdroj: | Applied Clinical Informatics. :556-568 |
| ISSN: | 1869-0327 |
| Popis: | 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 |
| Databáze: | OpenAIRE |
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