Building on Antimicrobial Stewardship Programs Through Integration with Electronic Medical Records: The Australian Experience
Tóm tắt
Antimicrobial stewardship (AMS) is well established in Australian hospitals. Electronic medical record (EMR) implementation has lagged in Australia, with two Healthcare Information and Management Systems Society (HIMSS) Stage 6 hospitals and one Stage 7 hospital as of September 2020. Specific barriers faced by AMS teams with paper-based prescribing and medical records include real-time identification of antimicrobials orders; the ability to prospectively monitor antimicrobial use; and the integration of fundamental point of prescribing AMS principles into routine clinical practice. There are few local guidelines to assist Australian hospitals and AMS teams beyond “out of the box” EMR functionality. EMR implementation has enormous potential to positively impact AMS teams through more efficient workflows and the ability to expand the reach and coverage of AMS activities. There are inevitable limitations associated with EMR implementation that must be considered. In this paper, four Australian hospitals share their experience with EMR roll out, AMS customisation and how they have overcome specific barriers in local AMS practice.
Tài liệu tham khảo
Cairns KA, Roberts JA, Cotta MO, Cheng AC. Antimicrobial Stewardship in Australian hospitals and other settings. Infect Dis Ther. 2015;4(Suppl 1):27–38.
Pogue JM, Potoski BA, Postelnick M, Mynatt RP, Trupiano DP, Eschenauer GA, et al. Bringing the “power” to Cerner’s PowerChart for antimicrobial stewardship. Clin Infect Dis. 2014;59(3):416–24.
Kullar R, Goff DA, Schulz LT, Fox BC, Rose WE. The “epic” challenge of optimizing antimicrobial stewardship: the role of electronic medical records and technology. Clin Infect Dis. 2013;57(7):1005–13.
Kuper KM, Nagel JL, Kile JW, May LS, Lee FM. The role of electronic health record and “add-on” clinical decision support systems to enhance antimicrobial stewardship programs. Infect Control Hosp Epidemiol. 2019;40(5):501–11.
HIMSS Electronic Medical Record Adoption Model. HIMSS website. 2017. https://www.himssanalytics.org/emram. Accessed 29 Sep 2020.
Grant J. eMedications growing across the country. J Pharm Pract Res. 2020;50(5):373-4.
HIMSS Stage 6 & 7 Achievement. HIMSS website. 2017. https://www.himssanalytics.org/stage-6-7-achievement. Accessed 29 Sep 2020.
Australian Commission on Safety and Quality in Health Care. Electronic medication management systems: a guide to safe implementation. 3rd edition. Sydney: ACSQHC; 2019.
Australian Commission on Safety and Quality in Health Care. Electronic Medication Management Systems Business Requirements. An addendum to Electronic Medication Management Systems: A guide to safe implementation. 3rd edition. Sydney: ACSQHC; 2019.
Australian Commission on Safety and Quality in Health Care. In: Antimicrobial Stewardship in Australian Health Care 2018. Sydney: ACSQHC; 2018.
Integrated electronic medical record (ieMR). Queensland Government website. 2019. https://www.health.qld.gov.au/clinical-practice/innovation/digital-health-initiatives/queensland/integrated-electronic-medical-record-iemr. Accessed 6 Mar 2020.
Cairns KA, Jenney AW, Abbott IJ, Skinner MJ, Doyle JS, Dooley M, et al. Prescribing trends before and after implementation of an antimicrobial stewardship program. Med J Aust. 2013;198(5):262–6.
Rawlins MDM, Raby E, Sanfilippo FM, Douglass R, Chambers J, McLellan D, et al. Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds. Int J Qual Health Care. 2018;30(8):637–41.
Doukas FF, Cheong E, McKew G, Gray T, McLachlan AJ, Gottlieb T. Antimicrobial Stewardship Audit and Feedback rounds: moving beyond the restricted antibiotic list and the impact of electronic systems. Intern Med J. 2020. https://doi.org/10.1111/imj.14979.
Adler-Milstein J, Holmgren AJ, Kralovec P, Worzala C, Searcy T, Patel V. Electronic health record adoption in US hospitals: the emergence of a digital “advanced use” divide. J Am Med Inform Assoc. 2017;24(6):1142–8.
Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2017.
Australian Government Department of Health. Australia’s National Antimicrobial Resistance Strategy – 2020 and Beyond. Canberra: Australian Government; 2019. https://www.amr.gov.au/resources/australias-national-antimicrobial-resistance-strategy-2020-and-beyond.
Lim LL, D’Arcy-Evans K, Koning S. Electronic medication management. Aust Prescr. 2018;41(4):100.
Keasberry J, Scott IA, Sullivan C, Staib A, Ashby R. Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice. Aust Health Rev. 2017;41(6):646–64.
Beaulac K, Corcione S, Epstein L, Davidson LE, Doron S. Antimicrobial stewardship in a long-term acute care hospital using offsite electronic medical record audit. Infect Control Hosp Epidemiol. 2016;37(4):433–9.
Cook PP, Rizzo S, Gooch M, Jordan M, Fang X, Hudson S. Sustained reduction in antimicrobial use and decrease in methicillin-resistant Staphylococcus aureus and Clostridium difficile infections following implementation of an electronic medical record at a tertiary-care teaching hospital. J Antimicrob Chemother. 2010;66(1):205–9.
Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–77.
Krive J, Shoolin JS, Zink SD. Effectiveness of evidence-based pneumonia CPOE order sets measured by health outcomes. Online J Public Health Inform. 2015;7(2):e211.
CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2019. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.
National Centre for Antimicrobial Stewardship and Australian Commission on Safety and Quality in Health Care. Antimicrobial prescribing practice in Australian hospitals: results of the 2018 Hospital National Antimicrobial Prescribing Survey. Sydney: ACSQHC; 2020.
Australian Commission on Safety and Quality in Health Care. Antimicrobial Stewardship Clinical Care Standard. Sydney: ACSQHC; 2020.
McNeil V, Cruickshank M, Duguid M. Safer use of antimicrobials in hospitals: the value of antimicrobial usage data. Med J Aust. 2010;193(S8):S114–7.
Moehring RW, Anderson DJ, Cochran RL, Hicks LA, Srinivasan A, Dodds Ashley ES. Expert consensus on metrics to assess the impact of patient-level antimicrobial stewardship interventions in acute-care settings. Clin Infect Dis. 2017;64(3):377–83.
Donisi V, Sibani M, Carrara E, Del Piccolo L, Rimondini M, Mazzaferri F, et al. Emotional, cognitive and social factors of antimicrobial prescribing: can antimicrobial stewardship intervention be effective without addressing psycho-social factors? J Antimicrob Chemother. 2019;74(10):2844–7.
Hulscher ME, Grol RP, van der Meer JW. Antibiotic prescribing in hospitals: a social and behavioural scientific approach. Lancet Infect Dis. 2010;10(3):167–75.
Charani E, Holmes A. Antibiotic Stewardship-twenty years in the making. Antibiotics (Basel). 2019;8:1.
Rawlins MDM, Sanfilippo FM, Ingram PR, McLellan DGJ, Crawford C, D’Orsogna L, et al. Optimizing adherence to advice from antimicrobial stewardship audit and feedback rounds. J Chemother. 2018;30(1):59–62.
Devchand M, Stewardson AJ, Urbancic KF, Khumra S, Mahony AA, Walker S, et al. Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: assessing the “five moments of antimicrobial prescribing.” Infect Control Hosp Epidemiol. 2019;40(10):1170–5.
Morton JB, Curzake DJ, Morrill HJ, Parente DM, Gaitanis MM, LaPlante KL. Verbal communication with providers improves acceptance of antimicrobial stewardship interventions. Infect Control Hosp Epidemiol. 2016;37(6):740–2.