Quality of antimicrobial prescribing improved by the introduction of ePrescribing at Auckland City Hospital

Improving antimicrobial prescribing is a difficult process often requiring labour-intensive, multi-modal interventions. Many hospitals have introduced ePrescribing systems but the effect on antimicrobial prescribing, without treatment choice decision support systems, has not been well described. We sought to determine whether the introduction of ePrescribing improved prescribing quality. Patient records for inpatients on four rehabilitation wards, two using ePrescribing and two using the National Medication Chart, during February 2017, were retrospectively reviewed to identify all antimicrobial prescriptions, which were then reviewed for quality. Documentation of indication was significantly better on ePrescribing wards (45/46, 98%) compared to National Medication Chart wards (47/59, 80%). Adherence to guidelines (32/46, 70% vs 33/59, 56%), appropriateness of therapy (42/46, 91% vs 50/59, 85%) and documentation of duration, stop or review dates (35/46, 76% vs 38/59, 64%) did not significantly differ. ePrescribing can improve the quality of antimicrobial prescribing when Antimicrobial Stewardship principles are used in system customisation but cannot address all factors impacting on prescribing quality.

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

Background

The implementation of electronic prescribing and medication administration (EPMA) systems is a priority for hospitals and a potential component of antimicrobial stewardship (AMS).

Objectives

To identify software features within EPMA systems that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features.

Methods

A questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann-Whitney U -test.

Results

Responses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). Of the pharmacists, 59% had experience of EPMA in their hospitals compared with 35% of microbiologists. Pharmacists assigned higher priority to indication prompt ( P  <   0.001), allergy checker ( P  =   0.003), treatment protocols ( P  =   0.003), drug-indication mismatch alerts ( P  =   0.031) and prolonged course alerts ( P  =   0.041) and lower priority to a dose checker for adults ( P  =   0.02) and an interaction checker ( P  <   0.05) than microbiologists. A 'soft stop' functionality was rated essential or high priority by 89% of respondents. Potential EPMA software features were expected to have the greatest impact on stewardship, treatment efficacy and patient safety outcomes with lowest impact on Clostridium difficile infection, antimicrobial resistance and drug expenditure.

Conclusions

The survey demonstrates key differences in health professionals' opinions of potential healthcare benefits of EPMA, but a consensus of anticipated positive impact on patient safety and AMS.