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THE IMPACT OF A NOVEL CLINICAL DECISION SUPPORT SYSTEM ON ANTIMICROBIAL STEWARDSHIP AT AN ACUTE NHS TEACHING HOSPITAL
European Statement
Clinical Pharmacy Services
Author(s)
Stephen Hughes, Katie Heard
Why was it done?
The context, strategies, and delivery of AMS vary markedly between hospitals, largely falling within two headings, that of restriction or enablement. Restricted access to broad-spectrum antimicrobials through pharmacy and microbiology control of supply is the most common approach as requires minimal resource and implementation. This controls antimicrobial misuse but the long term benefits are less clear. The negative professional culture this restriction develops may erode inter-professional trust and delay time to first-dose, negatively impacting upon sepsis management whilst approval is sought. CDSS was used to transform the working role of the AMS team.
What was done?
A real-time clinical decision support system (CDSS) has been tested and implemented for the first time in an acute NHS hospital. CDSS has enabled the service evolve from an effective restricted antimicrobial stewardship (AMS) service to a more desirable enablement service, where the team aspires to support all prescribers to take responsibility for good AMS practice
How was it done?
In April 2016 a commercial CDSS was introduced at a single site London teaching hospital with an established, multi-professional AMS team. A service evaluation was conducted to understand the impact of CDSS on practice. Data was collected for three months pre and post implementation, including time spent compiling data for AMS daily ward round, the number and types of ABX-related interventions made and total antimicrobial use (defined daily dose [DDD] per 100 occupied bed days [OBDs]).
What has been achieved?
Implementation of CDSS saw a transformation of the AMS service from tele-consult service from the microbiology labs to a patient-facing ward based service, through use of mobile technology. The relocation of AMS team staff resource allowed for increase ward presence and daily ward rounds on surgical, medical and admission wards. AMS interventions increased (138/quarter to 298/quarter) post-intervention. Clinician acceptance of AMS team interventions increased from 81% to 98%. High-impact interventions, such as escalation of septic patients, early discharge and ID reviews, increased on the ward based reviews. Total ABX (DDD/100OBD) reduced by 18% over study period.
What next?
The CDSS is being used to evolve the service to further support AMS practice. Patient orientated outcome data is being collected and used to drive further service improvements