Developing Clinical Decision Support within a Commercial Electronic Health Record System to Improve Antimicrobial Prescribing in the Neonatal ICU

R.S. Hum; K. Cato; B. Sheehan; S. Patel; J. Duchon; P. DeLaMora; Y.H. Ferng; P. Graham; D.K. Vawdrey; J. Perlman; E. Larson; L. Saiman

doi:10.4338/ACI-2013-09-RA-0069

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2014; 05(02): 368-387
DOI: 10.4338/ACI-2013-09-RA-0069

Research Article

Schattauer GmbH

Developing Clinical Decision Support within a Commercial Electronic Health Record System to Improve Antimicrobial Prescribing in the Neonatal ICU

Authors

R.S. Hum

¹Department of Pediatrics, Columbia University, NY, NY
K. Cato

²School of Nursing, Columbia University, NY, NY
B. Sheehan

³Faculty Practice Organization, Columbia University, NY, NY
S. Patel

⁵Department of Pediatrics, Northwestern University, Chicago, IL
J. Duchon

¹Department of Pediatrics, Columbia University, NY, NY
P. DeLaMora

⁶Department of Pediatrics, Weill Cornell Medical College, NY, NY
Y.H. Ferng

²School of Nursing, Columbia University, NY, NY
P. Graham

¹Department of Pediatrics, Columbia University, NY, NY

⁷Department of Quality and Patient Safety, NewYork-Presbyterian Hospital, NY, NY

⁸Department of Infection Prevention & Control, NewYork-Presbyterian Hospital, NY, NY
D.K. Vawdrey

⁴Department of Biomedical Informatics, Columbia University, NY, NY
J. Perlman

⁶Department of Pediatrics, Weill Cornell Medical College, NY, NY
E. Larson

²School of Nursing, Columbia University, NY, NY

⁹School of Nursing and Mailman School of Public Health, Columbia University, NY, NY
L. Saiman

¹Department of Pediatrics, Columbia University, NY, NY

⁸Department of Infection Prevention & Control, NewYork-Presbyterian Hospital, NY, NY

Abstract

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Keywords

Antimicrobial stewardship - clinical decision support - neonatal intensive care unit - implementation

References

References
1 Bizzarro MJ, Gallagher PG. Antibiotic-resistant organisms in the neonatal intensive care unit. Semin Perinatol 2007; 31 (Suppl. 01) 26-32.
2 Carey AJ, Della-Latta P, Huard R, Wu F, Graham PL, 3rd Carp D, Saiman L. Changes in the molecular epidemiological characteristics of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2010; 31 (Suppl. 06) 613-619.
3 Duchon J, Graham Iii P, Della-Latta P, Whittier S, Carp D, Bateman D, Saiman L. Epidemiology of enter-ococci in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2008; 29 (Suppl. 04) 374-376.
4 Gupta A, Della-Latta P, Todd B, San Gabriel P, Haas J, Wu F, Rubenstein D, Saiman L. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol 2004; 25 (Suppl. 03) 210-215.
5 Arnold C. Decreasing antibiotic overuse in neonatal intensive care units: quality improvement research. Proc (Bayl Univ Med Cent) 2005; 18 (Suppl. 03) 280-284.
6 Patel SJ, Oshodi A, Prasad P, Delamora P, Larson E, Zaoutis T, Paul DA, Saiman L. Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance. Pediatr Infect Dis J 2009; 28 (12) 1047-1051.
7 Patel SJ, Saiman L. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship. Clin Perinatol 2010; 37 (Suppl. 03) 547-563.
8 Bailey TC, Troy McMullin S. Using information systems technology to improve antibiotic prescribing. Crit Care Med 2001; 29 (Suppl. 04) N87-N91.
9 Giske CG, Monnet DL, Cars O, Carmeli Y. ReAct-Action on Antibiotic Resistance. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 2008; 52 (Suppl. 03) 813-821.
10 Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM. Society for Healthcare Epidemiology of America.. 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 (Suppl. 02) 159-177.
11 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330 7494 765.
12 Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Natl Academy Pr; 2000.
13 Morris AH. Decision support and safety of clinical environments. Qual Saf Health Care 2002; 11 (Suppl. 01) 69-75.
14 Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme Jr. JF, Lloyd JF, Burke JP. A computer-assisted management program for antibiotics and other antiinfective agents. The New England Journal of Medicine 1998; 338 (Suppl. 04) 232-238.
15 Currie L, Sheehan B, Graham PL, Stetson P, Cato K, Wilcox A. Sociotechnical analysis of a neonatal ICU. Stud Health Technol Inform 2009; 146: 258-262.
16 Patel S, Landers T, Larson E, Zaoutis T, Delamora P, Paul DA, Wong-McLoughlin J, Ferng Y-H, Saiman L. Clinical vignettes provide an understanding of antibiotic prescribing practices in neonatal intensive care units. Infect Control Hosp Epidemiol 2011; 32 (Suppl. 06) 597-602.
17 Patel SJ, Saiman L, Duchon JM, Evans D, Ferng Y-H, Larson E. Development of an antimicrobial steward-ship intervention using a model of actionable feedback. Interdiscip Perspect Infect Dis 2012; 2012: 150367.
18 MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev 2005; 18 (Suppl. 04) 638-656.
19 Ohl CA, Luther VP. Antimicrobial stewardship for inpatient facilities. J Hosp Med 2011; 6 (Suppl. 01) S4-S15.
20 Microsoft Corporation. Available from: http://www.microsoft.com/net. (last accessed: January 10, 2014)
21 Leibovici L, Paul M, Nielsen AD, Tacconelli E, Andreassen S. The TREAT project: decision support and prediction using causal probabilistic networks. Int J Antimicrob Agents 2007; 30 (Suppl. 01) S93-S102.
22 Mullett CJ, Evans RS, Christenson JC, Dean JM. Development and impact of a computerized pediatric antiinfective decision support program. Pediatrics 2001; 108 (Suppl. 04) E75.
23 Pestotnik SL, Classen DC, Evans RS, Burke JP. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Annals of internal medicine 1996; 124 (10) 884-890.
24 Samore MH, Bateman K, Alder SC, Hannah E, Donnelly S, Stoddard GJ, Haddadin B, Rubin MA, Williamson J, Stults B, Rupper R, Stevenson K. Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. JAMA 2005; 294 (18) 2305-2314.
25 Shebl NA, Franklin BD, Barber N. Clinical decision support systems and antibiotic use. Pharm World Sci 2007; 29 (Suppl. 04) 342-349.
26 Sintchenko V, Coiera E, Gilbert GL. Decision support systems for antibiotic prescribing. Curr Opin Infect Dis 2008; 21 (Suppl. 06) 573-579.
27 Sintchenko V, Iredell JR, Gilbert GL, Coiera E. Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care. J Am Med Inform Assoc 2005; 12 (Suppl. 04) 398-402.
28 Garibaldi RA. Computers and the quality of care--a clinician’s perspective. The New England Journal of Medicine 1998; 338 (Suppl. 04) 259-260.
29 Centers for Medicare & Medicaid Services. Available from: http://www.cms.gov/RegulationsandGuid ance/Legislation/EHRIncentivePrograms/index.html. (last accessed: January 10, 2014)
30 Kibbe DC. A physician’s guide to the Medicare and Medicaid EHR incentive programs: the basics. Family practice management 2010; 17 (Suppl. 05) 17-21.
31 Grigoraev L, Salikhov M. Financial Crisis 2008: Entering Global Recession. Problems of Economic Transition 2009; 51 (10) 35-62.

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