Methods: Using change management principles and tools including stakeholder engagement, data gathering, Plan Do Check Act (PDCA), and rapid cycle testing, we attempted to change practicing culture at CCHS across 3 ED locations. Our project team successfully addressed organizational behaviors, project barriers and organizational goals, culminating in the development and integration of an electronic ED PNA clinical decision support rule (ED-PNA-CDS) for IAbxR selection. Post implementation of the ED-PNA-CDS tool, a fifty patient retrospective chart review was conducted to assess the rate of IAbxR compliance with CCHS-ASP guidelines for adult patients admitted to the hospital through the ED with PNA.
Results: The ED-PNA-CDS launched for all ED providers on February 17, 2015. To date a total of 699 CDS activations have occurred with 183 activations specific for PNA. The ED-PNA-CDS opt out rate was 8.2% (15/183). The post project rate of IAbxR compliance was 90% (p = 0.0002). Fluoroquinolones were only used in patients with a severe beta lactam allergy.
Conclusion: The development and integration of an electronic ED-PNA-CDS resulted in significant culture change by increasing IAbxR compliance from 55% to 90% for adult ED patients admitted with PNA. Other potential benefits that warrant further investigation include improved clinical patient outcomes, broader institutional antimicrobial stewardship, and improved financial performance for CCHS (ie: reimbursement, length of stay, drug cost).
K. Taylor, None
J. Lacolla, None