Conversion of a single-facility pediatric antimicrobial stewardship program to multi-facility application with...

Area of Science:

• Health Informatics
• Pediatric Antimicrobial Stewardship
• Clinical Pharmacy

Background:

• Antimicrobial stewardship programs (ASPs) are crucial for optimizing antimicrobial use and enhancing patient safety.
• Transitioning from paper-based to electronic order sets requires careful adaptation of ASP recommendations.
• Standardizing ASP expertise across a health system is essential for consistent quality of care.

Purpose of the Study:

• To adapt an established pediatric antimicrobial stewardship program (ASP) for a computerized provider order entry (CPOE) system.
• To maintain consistency in ASP recommendations during CPOE implementation.
• To facilitate the dissemination of specialized pediatric ASP expertise to other hospitals within the health system.

Main Methods:

• Nine hospitals within a shared health system implemented pediatric CPOE using a common platform (Cerner Millennium).
• ASP clinicians developed 60 distinct electronic order sets (PowerPlans) for flexible integration into larger electronic orders.
• Incident reports and medication variance data were analyzed to assess the effectiveness of the ASP adaptation during CPOE rollout.

Main Results:

• Over 15,000 PowerPlan orders were placed in the first 30 days; 43 ASP-designed PowerPlans were used 1,149 times (7.2% of total).
• Of 437 documented incidents during CPOE implementation, only 1.1% were linked to ASP content or workflow.
• ASP-related errors constituted 2.9% of all medication variances post-CPOE implementation.

Conclusions:

• The integration of antimicrobial stewardship program content and workflow into CPOE generated proportionally fewer incidents than anticipated.
• A well-defined, modular ASP design supported successful CPOE implementation and the expansion of pediatric ASP expertise to affiliate hospitals.