In Singapore General Hospital, use of the Computerized Decision Support System (CDSS) is mandatory when antibiotics audited by the hospital antimicrobial stewardship program (ASP) are prescribed. It was envisioned that CDSS could, in part, replace need for ASP review via prospective audit-feedback (PAF). However, quality of CDSS use is prescriber-dependent, and inappropriate use (diagnosis selected is incongruent with antibiotic indication specified in patient notes) was observed. We investigated the role of prescriber enablement and engagement as strategies to improve CDSS appropriateness rates (CAR).
A series of interventions was rolled-out in January 2018. Intervention1 (I1) was implemented hospital-wide - expanded repertoire of antibiotic guidelines, display of CDSS selected diagnosis on the hospital’s electronic medical record, education and publicity via mass emails. Intervention 2 (I2) involved conducting additional roadshows but only in selected clinical departments (1 major medical and 2 major surgical departments). CAR (prospectively evaluated by ASP team) 3-months pre- and post-implementation of these interventions were compared using interrupted time-series analysis. Its potential impact on ASP manpower in place of PAF (30mins/case) was estimated.
An average of 1043 antibiotic courses, piperacillin-tazobactam (75.7%) as the most common, was prescribed with CDSS per month. Unspecified sepsis (51.5%) was the most common indication. Departments with I1 alone had mediocre improvement in CAR [66.8% (n=1699) vs. 68.9% (n=1760), p=0.10], while departments that received a combination of I1 and I2 saw greater improvement in CAR, with a trend towards statistical significance [60.4% (n=354) vs. 68.3% (n=393), p=0.07]. Improvement in CAR was most apparent in the surgical departments (50.6% vs. 59.4%, p=0.09). This absolute increment in CAR meant manpower savings of 6.5 hours/month, and could potentially reach 41 hours/month had both interventions been implemented and similar results achieved hospital-wide.
Active prescriber engagement is pivotal in effectively obtaining buy-in to and success of ASP strategies.
S. S. L. Tang,
L. Loo, None
A. L. Kwa, None
P. Chlebicki, None
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