Designing a Clinical Decision Support Prototype for Urinary Tract Infection Treatment in Nursing Homes: Experiences...

Area of Science:

• Gerontology
• Infectious Diseases
• Health Informatics

Background:

• Inappropriate antibiotic use is common in nursing homes (NHs), increasing risks for older adults and antimicrobial resistance.
• Urinary tract infections (UTIs) represent a significant portion of NH antibiotic prescriptions, often with inappropriate use.
• Clinical decision support (CDS) integrated into electronic prescribing systems offers a potential solution to enhance antibiotic appropriateness.

Purpose of the Study:

• To develop a CDS prototype aimed at optimizing antibiotic prescribing for UTIs in NHs.
• To collaborate with an IT provider (BESTMED) and healthcare professionals to define and build the CDS tool.
• To identify key areas for improvement in antibiotic choice and treatment duration for UTIs in NHs.

Main Methods:

• Utilized electronic health record data to establish CDS goals.
• Conducted design workshops with IT developers and infectious diseases physicians.
• Developed a CDS prototype featuring alerts for non-guideline-concordant antibiotic choice and duration.

Main Results:

• Identified antibiotic choice and treatment duration as critical targets for CDS intervention.
• The CDS prototype provides alerts when prescribing deviates from established guidelines.
• Addressed the challenge of integrating the CDS seamlessly into existing electronic prescribing workflows.

Conclusions:

• The developed CDS prototype has the potential to improve UTI antibiotic prescribing in NHs.
• User testing and piloting are planned to evaluate the CDS usability, acceptability, and effectiveness.
• This intervention aims to mitigate adverse events and curb antimicrobial resistance in NH residents.