Developing Clinical Decision Support within a Commercial Electronic Health Record System to Improve Antimicrobial Prescribing in the Neonatal ICU
| Autor: | Jeffrey M. Perlman, R. S. Hum, Jennifer Duchon, Barbara Sheehan, Kenrick Cato, Yu-hui Ferng, Elaine Larson, Philip L. Graham, David K. Vawdrey, Sameer J. Patel, Patricia DeLaMora, Lisa Saiman |
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| Rok vydání: | 2014 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Neonatal intensive care unit Sociotechnical system 030106 microbiology Health Informatics Personal Satisfaction Drug Prescriptions Clinical decision support system 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents Health Information Management Intensive Care Units Neonatal Intensive care medicine Information system Electronic Health Records Humans Antimicrobial stewardship 030212 general & internal medicine Intensive care medicine Data collection business.industry Data Collection Infant Newborn Information technology Decision Support Systems Clinical medicine.disease Computer Science Applications Medical emergency business Research Article |
| Zdroj: | Applied Clinical Informatics. :368-387 |
| ISSN: | 1869-0327 |
| DOI: | 10.4338/aci-2013-09-ra-0069 |
| Popis: | SummaryObjective: 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.Citation: Hum RS, Cato K, Sheehan B, Patel S, Duchon J, DeLaMora P, Ferng YH, Graham P, Vawdrey DK, Perlman J, Larson E, Saiman L. Developing clinical decision support within a commercial electronic health record system to improve antimicrobial prescribing in the neonatal ICU. Appl Clin Inf 2014; 5: 368–387 http://dx.doi.org/10.4338/ACI-2013-09-RA-0069 |
| Databáze: | OpenAIRE |
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