Embedding simplified antimicrobial stewardship order sets improves antibiotic prescribing
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Embedding simplified antimicrobial stewardship electronic order sets improved antibiotic prescribing for community-acquired pneumonia, UTIs and skin and soft tissue infections at a Canadian hospital, researchers said.
“We had antimicrobial stewardship (AS) electronic order sets (EOSs) that included recommended empiric antibiotic therapies for common infections such as community-acquired pneumonia (CAP), UTIs and skin and soft tissue infections (SSTIs) in place for a number of years. However, we found that these EOSs were barely used, less than 10 times annually,” April J. Chan, PharmD, pharmacist at St. Joseph’s Health Centre at Unity Health Toronto, told Healio.
Chan added that the general medicine admission EOS is “mostly used in the ED” at her institution. Her research team wanted to simplify the EOS for CAP, UTIs and SSTIs — specifically, they included only antibiotic selection from the existing standalone ASP EOS — and embed it into the general medicine admission EOS to improve prescribing and increase uptake of the AS EOS.
Chan and colleagues conducted a before-and-after study at their community hospital in Toronto that compared the periods Jan. 1, 2016, to March 29, 2017 — before the intervention took place — and March 30, 2017 to June 30, 2018.
Chan said the study demonstrated a large increase in the use of the embedded EOS. According to the study, there was an 11-fold increase (355 vs. 32) for the CAP EOS, a 47-fold increase (94 vs. 2) for the UTI EOS and a 24-fold increase for SSTI EOS use. Chan explained that this was not seen in other AS EOSs that were not embedded, except for the 16-fold increase in Clostridioides difficile EOS use. Researchers attributed the increased use in the C. difficile EOS to a guideline update from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America that occurred during the study period which they say may have prompted renewed interest from prescribers to check the institution's EOS.
“Our study showed a creative approach to increase uptake of antimicrobial stewardship empiric antibiotic recommendations by leveraging existing information technology resources,” Chan concluded. “We hope that other institutions can adopt a similar intervention to ours in order to nudge empiric antibiotic prescribing at their sites.”
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