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Use of a Computer Decision Support System and Antimicrobial Therapy Appropriateness

Published online by Cambridge University Press:  02 January 2015

Gregory A. Filice ,
Dimitri M. Drekonja ,
Joseph R. Thurn ,
Thomas S. Rector ,
Galen M. Hamann ,
Bobbie T. Masoud ,
Anne-Marie Leuck ,
Curtis L. Nordgaard ,
Meredith K. Eilertson  and
James R. Johnson
Gregory A. Filice*
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Infectious Disease Section, Department of Medicine, University of Minnesota at Minneapolis, Minneapolis, Minnesota
Dimitri M. Drekonja
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Infectious Disease Section, Department of Medicine, University of Minnesota at Minneapolis, Minneapolis, Minnesota
Joseph R. Thurn
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Infectious Disease Section, Department of Medicine, University of Minnesota at Minneapolis, Minneapolis, Minnesota
Thomas S. Rector
Affiliation:
Center for Chronic Disease Outcomes Research, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota
Galen M. Hamann
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
Bobbie T. Masoud
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
Anne-Marie Leuck
Affiliation:
Infectious Disease Section, Department of Medicine, University of Minnesota at Minneapolis, Minneapolis, Minnesota
Curtis L. Nordgaard
Affiliation:
School of Medicine, University of Minnesota at Minneapolis, Minneapolis, Minnesota
Meredith K. Eilertson
Affiliation:
School of Pharmacy, University of Minnesota at Minneapolis, Minneapolis, Minnesota
James R. Johnson
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Infectious Disease Section, Department of Medicine, University of Minnesota at Minneapolis, Minneapolis, Minnesota
*
Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN 55417 (filic001@umn.edu).
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Abstract

Objective.

To determine whether antimicrobial (AM) courses ordered with an antimicrobial computer decision support system (CDSS) were more likely to be appropriate than courses ordered without the CDSS.

Design.

Retrospective cohort study. Blinded expert reviewers judged whether AM courses were appropriate, considering drug selection, route, dose, and duration.

Setting.

A 279-bed university-affiliated Department of Veterans Affairs (VA) hospital.

Patients.

A 500-patient random sample of inpatients who received a therapeutic AM course between October 2007 and September 2008.

Intervention.

An optional CDSS, available at the point of order entry in the VA computerized patient record system.

Results.

CDSS courses were significantly more likely to be appropriate (111/254, 44%) compared with non-CDSS courses (81/246, 33%, P = .013). Courses were more likely to be appropriate when the initial provider diagnosis of the condition being treated was correct (168/273, 62%) than when it was incorrect, uncertain, or a sign or symptom rather than a disease (24/227, 11%, P< .001). In multivariable analysis, CDSS-ordered courses were more likely to be appropriate than non-CDSS-ordered courses (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.13–2.98). Courses were also more likely to be judged appropriate when the initial provider diagnosis of the condition being treated was correct than when it was incorrect, uncertain, or a sign or symptom rather than a disease (OR, 3.56; 95% CI, 1.4-9.0).

Conclusions.

Use of the CDSS was associated with more appropriate AM use. To achieve greater improvements, strategies are needed to improve provider diagnoses of syndromes that are infectious or possibly infectious.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 6 , June 2013 , pp. 558 - 565
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Smolinski, M, Hamburg, M, Lederberg, J. Microbial Threats to Health: Emergence, Detection, and Response. Washington, DC: National Academies; 2003.Google Scholar
2.Bartlett, JG. A call to arms: the imperative for antimicrobial stewardship. Clin Infect Dis 2011;53(Suppl 1):S4–S7.CrossRefGoogle Scholar
3.European Centre for Disease Prevention and Control and European Medicines Agency. ECDC/EMEA joint technical report: the bacterial challenge: time to react. Stockholm: European Centre for Disease Prevention and Control and European Medicines Agency; 2009. http://www.ecdc.europa.eu/en/publications/Publications/0909_TER_The_Bacterial_Challenge_Time_to_React.pdf. Accessed December 29, 2011.Google Scholar
4.Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012;33:322–327.CrossRefGoogle Scholar
5.Boucher, HW, Talbot, GH, Bradley, JS, et al.Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1–12.CrossRefGoogle ScholarPubMed
6.Dellit, TH, Owens, RC, McGowan, JE, et al.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;44:159–177.CrossRefGoogle Scholar
7.Micek, ST, Welch, EC, Khan, J, et al.Empiric combination antibiotic therapy is associated with improved outcome against sepsis due to gram-negative bacteria: a retrospective analysis. Antimicrob Agents Chemother 2010;54:1742–1748.CrossRefGoogle ScholarPubMed
8.Kollef, MH, Sherman, G, Ward, S, Fraser, VJ. Inadequate anti-microbial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462–474.CrossRefGoogle Scholar
9.Classen, DC, Pestotnik, SL, Evans, RS, Burke, JP. Computerized surveillance of adverse drug events in hospital patients. JAMA 1991;266:2847–2851.CrossRefGoogle ScholarPubMed
10.Shehab, N, Patel, PR, Srinivasan, A, Budnitz, DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 2008;47:735–743.CrossRefGoogle ScholarPubMed
11.Ohl, CA, Luther, VP. Antimicrobial stewardship for inpatient facilities. J Hosp Med 2011;6(Suppl 1):S4–S15.CrossRefGoogle ScholarPubMed
12.Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972–978.CrossRefGoogle ScholarPubMed
13.File, TM JrSolomkin, JS, Cosgrove, SE. Strategies for improving antimicrobial use and the role of antimicrobial stewardship programs. Clin Infect Dis 2011;53(Suppl 1):S15–S22.CrossRefGoogle ScholarPubMed
14.Davey, P, Brown, E, Fenelon, L, et al.Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2005;(4):CD003543.CrossRefGoogle Scholar
15.Thursky, K. Use of computerized decision support systems to improve antibiotic prescribing. Expert Rev Anti Infect Ther 2006;4:491–507.CrossRefGoogle ScholarPubMed
16.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.CrossRefGoogle ScholarPubMed
17.Welker, JA, Huston, M, McCue, JD. Antibiotic timing and errors in diagnosing pneumonia. Arch Intern Med 2008;168:351–356.CrossRefGoogle ScholarPubMed
18.Nicks, BA, Manthey, DE, Fitch, MT. The Centers for Medicare and Medicaid Services (CMS) community-acquired pneumonia core measures lead to unnecessary antibiotic administration by emergency physicians. Acad Emerg Med 2009;16:184–187.CrossRefGoogle ScholarPubMed
19.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
20.Schwartz, DN, Wu, US, Lyles, RD, et al.Lost in translation? reliability of assessing inpatient antimicrobial appropriateness with use of computerized case vignettes. Infect Control Hosp Epidemiol 2009;30:163–171.CrossRefGoogle ScholarPubMed
21. Veterans Health Administration Medicare and Medicaid Analysis Center, http://www.va.gov/medicareanalysis/. Accessed May 21, 2012.Google Scholar
22.Linkin, DR, Fishman, NO, Landis, JR, et al.Effect of communication errors during calls to an antimicrobial stewardship program. Infect Control Hosp Epidemiol 2007;28:1374–1381.CrossRefGoogle Scholar
23.Avorn, J, Solomon, DH. Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann Intern Med 2000;133:128–135.CrossRefGoogle ScholarPubMed
24.Evans, RS, Classen, DC, Pestotnik, SL, Lundsgaarde, HP, Burke, JP. Improving empiric antibiotic selection using computer decision support. Arch Intern Med 1994;154:878–884.CrossRefGoogle ScholarPubMed
25.Westphal, JF, Jehl, F, Javelot, H, Nonnenmacher, C. Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting. Pharmacoepidemiol Drug Saf 2011;20:162–168.CrossRefGoogle ScholarPubMed
26.Samore, MH, Bateman, K, Alder, SC, et al.Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. JAMA 2005;294:2305–2314.CrossRefGoogle ScholarPubMed
27.Bright, TJ, Wong, A, Dhurjati, R, et al.Effect of clinical decision-support systems: a systematic review. Ann Intern Med 2012;157:29–43.CrossRefGoogle ScholarPubMed
28.Evans, RS, Classen, DC, Pestotnik, SL, Lundsgaarde, HP, Burke, JP. Improving empiric antibiotic selection using computer decision support. Arch Intern Med 1994;154:878–884.CrossRefGoogle ScholarPubMed
29.McGregor, JC, Weekes, E, Forrest, GN, et al.Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial. J Am Med Inform Assoc 2006;13:378–384.CrossRefGoogle ScholarPubMed
30.Sintchenko, V, Coiera, E, Gilbert, GL. Decision support systems for antibiotic prescribing. Curr Opin Infect Dis 2008;21:573–579.CrossRefGoogle ScholarPubMed
31.Thursky, KA, Buising, KL, Bak, N, et al.Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit. Int J Qual Health Care 2006;18:224–231.CrossRefGoogle Scholar
32.Kaki, R, Elligsen, M, Walker, S, Simor, A, Palmay, L, Daneman, N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 2011;66:1223–1230.CrossRefGoogle ScholarPubMed
33.Charani, E, Cooke, J, Holmes, A. Antibiotic stewardship programmes: what's missing? J Antimicrob Chemother 2010;65:2275–2277.CrossRefGoogle ScholarPubMed
34.Classen, DC, Bates, DW. Finding the meaning in meaningful use. N Engl J Med 2011;365:855–858.CrossRefGoogle ScholarPubMed
35.Osheroff, JA, Teich, JM, Middleton, B, Steen, EB, Wright, A, Detmer, DE. A roadmap for national action on clinical decision support. J Am Med Inform Assoc 2007;14:141–145.CrossRefGoogle ScholarPubMed
36.Power, DJ. Decision Support Systems: Concepts and Resources for Managers. Westport, CT: Quorum; 2002.Google Scholar
37.LaRosa, LA, Fishman, NO, Lautenbach, E, Koppel, RJ, Morales, KH, Linkin, DR. Evaluation of antimicrobial therapy orders circumventing an antimicrobial stewardship program: investigating the strategy of “stealth dosing.” Infect Control Hosp Epidemiol 2007;28:551–556.CrossRefGoogle Scholar