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951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals

BACKGROUND: UPMC Antimicrobial stewardship (AS) includes independently functioning AS programs and a central tele antimicrobial stewardship (TASP) (1 ID pharmacist and 1 ID physician) that supports smaller hospitals with few on-site AS resources. We describe implementation of an AS clinical decision...

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Autores principales: Ryan Bariola, J, Khadem, Tina, Yakemowicz, Caley, Simonick, Courtney, McCreary, Erin K, Andrzejewski, Christina, Mellors, John W, Abdel-Massih, Rima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752447/
http://dx.doi.org/10.1093/ofid/ofac492.794
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author Ryan Bariola, J
Khadem, Tina
Yakemowicz, Caley
Simonick, Courtney
McCreary, Erin K
Andrzejewski, Christina
Mellors, John W
Abdel-Massih, Rima
author_facet Ryan Bariola, J
Khadem, Tina
Yakemowicz, Caley
Simonick, Courtney
McCreary, Erin K
Andrzejewski, Christina
Mellors, John W
Abdel-Massih, Rima
author_sort Ryan Bariola, J
collection PubMed
description BACKGROUND: UPMC Antimicrobial stewardship (AS) includes independently functioning AS programs and a central tele antimicrobial stewardship (TASP) (1 ID pharmacist and 1 ID physician) that supports smaller hospitals with few on-site AS resources. We describe implementation of an AS clinical decision support system (CDSS) at 19 UPMC hospitals (12-695 staffed beds). Figure 1 is an example of the CDSS. [Figure: see text] METHODS: The CDSS extracts clinical data to provide real-time alerts to AS teams. It also supports asynchronous communications between AS team members, including between a local AS and our TASP. CDSS utilization and intervention data from Oct 21 to Mar 22 are reported. Figure 2 shows hospital locations and the timeline for CDSS implementation. Table 1 shows implementation steps. [Figure: see text] [Figure: see text] RESULTS: Table 2 summarizes category alerts provided by the CDSS. Category 1 alerts were independently reviewed by local pharmacists. Category 2 alerts were reviewed either by local pharmacists or central TASP team. Figure 3 shows high CDSS usage over time with numerous unique users and frequent logins. Most users were pharmacists. CDSS usage was steady and increased in the final month included here. Communications between users were frequent and increased 46%. On average, 7033 CDSS generated alerts per month (70-798 per hospital) were reviewed from Oct 21 to Mar22. Table 3 groups the alerts into successful, unsuccessful, or nonactionable interventions. 93% of actionable alerts (959 of 1029 per month) produced a successful outcome. [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: After a rapid 5-month deployment across 19 hospitals this CDSS was successfully adopted as evidenced by sustained monthly use, increasing communications, and a high rate of accepted interventions on actionable alerts. A high rate of nonactionable alerts in the first 6 months was a limitation. Although this did not appear to limit CDSS use, sites implementing a CDSS should monitor for nonactionable alerts during early utilization and adjust as needed. CDSS has the potential to improve efficiency and consistency of AS within a health system. After a successful implementation, evaluation of impact on antimicrobial usage and clinical outcomes are important future metrics. DISCLOSURES: J Ryan Bariola, MD, Infectious Disease Connect: Salary support|Merck: Grant/Research Support Tina Khadem, PharmD, Infectious Disease Connect: Salary support|Merck: Grant/Research Support Caley Yakemowicz, n/a, Infectious Disease Connect: Employee Courtney Simonick, n/a, Infectious Disease Connect: Stocks/Bonds Erin K. McCreary, PharmD, AbbVie: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Summit: Advisor/Consultant Christina Andrzejewski, n/a, Melinta Therapeutics: employee John W. Mellors, MD, Abound Bio: Multiple|Abound Bio: Ownership Interest|Gilead Sciences: Advisor/Consultant|Infectious Disease Connect: Advisor/Consultant|Infectious Disease Connect: Ownership Interest Rima Abdel-Massih, MD, Infectious Disease Connect: Co founder and Chief Medical Officer|Infectious Disease Connect: Ownership Interest.
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spelling pubmed-97524472022-12-16 951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals Ryan Bariola, J Khadem, Tina Yakemowicz, Caley Simonick, Courtney McCreary, Erin K Andrzejewski, Christina Mellors, John W Abdel-Massih, Rima Open Forum Infect Dis Abstracts BACKGROUND: UPMC Antimicrobial stewardship (AS) includes independently functioning AS programs and a central tele antimicrobial stewardship (TASP) (1 ID pharmacist and 1 ID physician) that supports smaller hospitals with few on-site AS resources. We describe implementation of an AS clinical decision support system (CDSS) at 19 UPMC hospitals (12-695 staffed beds). Figure 1 is an example of the CDSS. [Figure: see text] METHODS: The CDSS extracts clinical data to provide real-time alerts to AS teams. It also supports asynchronous communications between AS team members, including between a local AS and our TASP. CDSS utilization and intervention data from Oct 21 to Mar 22 are reported. Figure 2 shows hospital locations and the timeline for CDSS implementation. Table 1 shows implementation steps. [Figure: see text] [Figure: see text] RESULTS: Table 2 summarizes category alerts provided by the CDSS. Category 1 alerts were independently reviewed by local pharmacists. Category 2 alerts were reviewed either by local pharmacists or central TASP team. Figure 3 shows high CDSS usage over time with numerous unique users and frequent logins. Most users were pharmacists. CDSS usage was steady and increased in the final month included here. Communications between users were frequent and increased 46%. On average, 7033 CDSS generated alerts per month (70-798 per hospital) were reviewed from Oct 21 to Mar22. Table 3 groups the alerts into successful, unsuccessful, or nonactionable interventions. 93% of actionable alerts (959 of 1029 per month) produced a successful outcome. [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: After a rapid 5-month deployment across 19 hospitals this CDSS was successfully adopted as evidenced by sustained monthly use, increasing communications, and a high rate of accepted interventions on actionable alerts. A high rate of nonactionable alerts in the first 6 months was a limitation. Although this did not appear to limit CDSS use, sites implementing a CDSS should monitor for nonactionable alerts during early utilization and adjust as needed. CDSS has the potential to improve efficiency and consistency of AS within a health system. After a successful implementation, evaluation of impact on antimicrobial usage and clinical outcomes are important future metrics. DISCLOSURES: J Ryan Bariola, MD, Infectious Disease Connect: Salary support|Merck: Grant/Research Support Tina Khadem, PharmD, Infectious Disease Connect: Salary support|Merck: Grant/Research Support Caley Yakemowicz, n/a, Infectious Disease Connect: Employee Courtney Simonick, n/a, Infectious Disease Connect: Stocks/Bonds Erin K. McCreary, PharmD, AbbVie: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Summit: Advisor/Consultant Christina Andrzejewski, n/a, Melinta Therapeutics: employee John W. Mellors, MD, Abound Bio: Multiple|Abound Bio: Ownership Interest|Gilead Sciences: Advisor/Consultant|Infectious Disease Connect: Advisor/Consultant|Infectious Disease Connect: Ownership Interest Rima Abdel-Massih, MD, Infectious Disease Connect: Co founder and Chief Medical Officer|Infectious Disease Connect: Ownership Interest. Oxford University Press 2022-12-15 /pmc/articles/PMC9752447/ http://dx.doi.org/10.1093/ofid/ofac492.794 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Ryan Bariola, J
Khadem, Tina
Yakemowicz, Caley
Simonick, Courtney
McCreary, Erin K
Andrzejewski, Christina
Mellors, John W
Abdel-Massih, Rima
951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals
title 951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals
title_full 951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals
title_fullStr 951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals
title_full_unstemmed 951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals
title_short 951. Implementation and Rapid Uptake of an Antimicrobial Stewardship Clinical Decision Support System Across 19 UPMC Hospitals
title_sort 951. implementation and rapid uptake of an antimicrobial stewardship clinical decision support system across 19 upmc hospitals
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752447/
http://dx.doi.org/10.1093/ofid/ofac492.794
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