Reducing incorrect antibiotic dosing and enhancing prescriber adherence through a real-time, patient-specific...

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Health Informatics

Background:

• Incorrect antibiotic dosing is a prevalent issue, especially in patients with renal impairment or obesity, leading to treatment failure and antimicrobial resistance.
• Existing clinical decision support systems (CDSS) often lack real-time, patient-specific dosing, hindering optimal antimicrobial therapy.

Purpose of the Study:

• To implement and evaluate a mandatory CDSS for restricted antibiotics to improve antibiotic dosing accuracy.
• To assess the impact of the CDSS on prescriber adherence and incorrect dosing rates in a tertiary hospital.

Main Methods:

• A mandatory CDSS was implemented for restricted antibiotics, integrating electronic medical record data (renal function, body weight) and prescriber-selected dialysis modality.
• Prescribers were required to accept recommendations or provide justification for overrides.
• Retrospective analysis of 81,164 prescriptions post-implementation and comparison with 41,550 pre-implementation prescriptions.

Main Results:

• CDSS adherence increased from 62.2% to 92.6% post-implementation.
• The incorrect antibiotic dosing rate decreased from 3.7% to 2.1% (P < 0.001).
• System refinements, including support for inhaled colistin and loading dose guidance, further enhanced usability and adherence.

Conclusions:

• The integrated CDSS significantly improved prescriber adherence and reduced incorrect antibiotic dosing by providing real-time, patient-specific, guideline-aligned recommendations.
• The system demonstrates substantial potential for enhancing medication safety and supporting antimicrobial stewardship efforts.