This poster highlighting antimicrobial stewardship clinical decision support system implementation was originally presented at IDWeek 2022, held Oct. 19-23 in Washington, D.C.
Ryan Bariola, M.D.1,2; Tina Khadem, PharmD1,2; Caley Yakemowicz2; Courtney Simonick2;
Erin McCreary, PharmD1,2; Christina Andrzejewski; John W. Mellors. M.D.1,2; Rima C. Abdel-Massih, M.D.1,2
Contact: bariolajr@upmc.edu
1. Division of Infectious Diseases, UPMC 2. Infectious Disease Connect, Pittsburgh, PA USA
Conclusions
- Having implemented a clinical decision support system (CDSS) for antimicrobial stewardship (AMS) across 19 hospitals in five months, the successful adoption and use of the software was demonstrated by increased monthly CDSS utilization and a high intervention acceptance rate.
- Communication within the software was frequent and increased over time. Despite a high rate of nonactionable alerts seen in the first six months of use, ILÚM Insight was frequently and consistently used in this multisite model.
- The CDSS facilitated high intervention rates and streamlined documentation at those hospitals without local ID expertise.
Background
- Antimicrobial stewardship (AMS) at UPMC consists of independently functioning programs and a hub-and-spoke tele-antimicrobial stewardship program (TASP) that typically supports smaller community hospitals with less on-site resources and expertise.
- In this study we describe the implementation of a clinical decision support system (CDSS) for AMS at 19 UPMC hospitals, which ranged in size from 12-695 staffed beds.
- Examples of the CDSS (Figure 1) and implementation locations (Figure 2) are included.
Methods
- This CDSS – ILÚM Insight® from Infectious Disease Connect – extracts electronic medical record (EMR) data to provide real-time alerts, facilitate communication among all end users in the UPMC system, and delivers asynchronous workflow across different team members. The adoption of this CDSS is further explained by the summarized categories of alerts included over time (Table 1).
- Category 1 alerts were independently reviewed by all local pharmacists.
- Category 2 alerts were reviewed either by local pharmacists, or by the TASP.
- CDSS utilization, intervention data, and balancing measures from October 2021 to March 2022.
- Implementation timeline (Figure 3).
Table 1
Category 1
- Beta-lactam allergy evaluation
- Duplicate anaerobic coverage
- IV to PO
- Active IV vancomycin with negative MRSA nasal screen
- Positive C. difficile
Category 2
- Antimicrobial timeout (48h, 72h or 96h)
- Broad spectrum beta-lactam agents
- Restricted antimicrobial
- Antipseudomonal agent without Pseudomonas in culture at 96 hours
- Bug-drug mismatch (all sources)
- De-escelation Susceptibility
- Positive blood culture
- Positive Cerebrospinal Fluid culture
Results
- Communications between various AMS members increased over time.
- An average of 7,033 alerts per month (70-798 per hospital) were reviewed between October 2021 and March 2022. (Figure 4 shows CDSS usage over time)
- Most CDSS users were pharmacists.
- 93% of alerts requiring intervention resulted in an accepted intervention.
- On average, 508 unique patients each month had an antibiotic restarted within 2-7 days of stopping that same antibiotic.
- Table 2 summarizes all the successful, unsuccessful, and nonactionable alerts.
Table 2
| Final Alert Status | Monthly Average (N) | Average Monthly Total Reviewed Alerts (N) | % of Total Reviewed Alerts | % of Actionable Alerts |
|---|---|---|---|---|
| Successful – Intervention Accepted | 959 | 7033 | 14% | 93% |
| Failures – Intervention Rejected | 70 | 7033 | 1% | 7% |
| Already Appropriate – Current therapy ok – No treatment needed | 1795 | 7033 | 26% | N/A |
| Nonactionable alerts – Duplicate alert – Discharged prior to intervention | 2694 | 7033 | 38% | N/A |
Disclosures
Rima Abdel-Massih is Co-founder, CMO, and share option holder of Infectious Disease Connect. John Mellors is Co-founder, Advisory Board Chair, and share option holder of Infectious Disease Connect. All other contributing authors have no disclosures.
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