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Published on: August 30, 2018
A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction
Allison L Agwu1, Carlton K K Lee, Sanjay K Jain
1Divisions of Pediatric Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Insights
A new web-based antimicrobial restriction program significantly improved antimicrobial stewardship, leading to substantial cost savings and increased user satisfaction. This digital tool enhances communication and efficiency in hospitals.
Area of Science:
- Healthcare Management
- Infectious Diseases
- Health Informatics
Background:
- Antimicrobial stewardship programs (ASPs) are crucial for reducing inappropriate hospital antimicrobial use.
- Existing antimicrobial restriction programs often face challenges requiring innovative solutions.
- A World Wide Web-based system was implemented at Johns Hopkins Children's Medical and Surgical Center to improve upon a previous restriction program.
Purpose of the Study:
- To design, implement, and evaluate a World Wide Web-based antimicrobial restriction program.
- To address identified opportunities for improvement in an existing antimicrobial restriction system.
- To enhance antimicrobial stewardship through improved decision support and communication.
Main Methods:
- A user survey informed the development of a web-based antimicrobial restriction program.
- The program provided automated clinical decision support, facilitated approvals, and improved real-time communication.
- Key metrics including user satisfaction, dose delays, dispensing times, and costs were evaluated before and after implementation.
Main Results:
- Significant projected annual cost reduction of $370,069 associated with restricted antimicrobial use.
- Reduced dispensed doses by 11.6% and decreased reports of missed/delayed doses by 21-32%.
- Increased user satisfaction from 22% to 68% (prescribers) and 13% to 69% (pharmacists); reduced pharmacy calls by 40%.
Conclusions:
- The web-based antimicrobial approval program significantly enhanced communication and antimicrobial administration efficiency.
- The program resulted in substantial cost savings and improved user satisfaction.
- Integrated digital tools like this web-based program are effective in strengthening antimicrobial stewardship efforts.
Background:
Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program.
Methods:
A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated.
Results:
After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy.
Conclusion:
The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web-based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.
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