Methods: Following the upgrade to Epic 2014, members of the Duke Antimicrobial Stewardship and Evaluation Team (ASET) met with Willow analysts to begin planning of the antimicrobial stewardship navigator in October 2014. The Antibiotic Monitoring Strategy Handbook and Epic Foundation 2014 were used to guide the build process for antibiotic monitoring workflows, pharmacy scoring systems, and patient lists.
Results: Development and implementation required a collaborative effort between administration, ASET, and Epic analysts, including meetings, review, and feedback up to twice per week. The navigator was instituted hospital-wide for all inpatients in April 2015. Approximately 250 hours were required to build the navigator, including alerts for Bug-Drug mismatches, Antimicrobial IV to PO switches, De-Escalation opportunities, and Drug-Lab mismatches. Documentation of the build was estimated at 120 hours and testing of build took approximately 100 hours with an additional 40 hours refining after the original release date. The Broad Spectrum Antibiotic Patient List was designated as the primary Antimicrobial Stewardship Program (ASP) list and contains an integrated scoring system used to identify patients qualifying for review. A restricted antimicrobial list was also created for all patients on antimicrobials requiring Infectious Disease approval. Both lists populate in real-time based on antimicrobial, laboratory, and diet orders, as well as microbiology results in the EMR. After rollout, ASET now efficiently targets 20-30 patients for stewardship interventions each day.
Conclusion: Hospital-wide implementation of the Epic antimicrobial stewardship navigator was achieved with substantial time and effort. The long and difficult process requires sufficient organizational resources (e.g., informatics pharmacists) for successful implementation.
P. Bush, None
C. Sarubbi, None
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