August 09, 2019
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Automated EMR tool improves antimicrobial stewardship

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Researchers customized a Pennsylvania hospital’s electronic medical record to automate antimicrobial stewardship documentation and found that the tweak increased the number of charts that could be reviewed and was associated with a decrease in antimicrobial use, drug resistance and Clostridioides difficile infections.

Michael Katzman, MD, FACP, FIDSA, professor of infectious diseases at Penn State College of Medicine and director of the antimicrobial stewardship program at Milton S. Hershey Medical Center, and colleagues noted that quality improvement and leadership support of antimicrobial stewardship programs hinge on documenting their actions and impact.

“An EMR can be adapted to track what an antimicrobial stewardship program (ASP) does by providing a standardized format for tallying the number of charts reviewed, types of ASP recommendations, to whom and by what means those recommendations were communicated, documenting whether the recommendations were followed and recording any effects on antimicrobial days of therapy,” Katzman told Infectious Disease News.

“This report describes how we harnessed the power of the EMR to improve the completeness and accuracy of our data entry and subsequent analysis, which has made our ASP more efficient and allowed us to expand our activities.”

They designed the hospital’s automated EMR documentation program to include a “novel and intuitive” ASP form that is created in any EMR open for review, and two exclusive tracking systems, “one for active forms to facilitate the daily ASP workflow and one for finalized forms to generate cumulative reports,” Katzman explained.

According to Katzman and colleagues, the system automated much of the documentation that ASP members had to complete manually, facilitated follow-up of interventions, improved data completeness and validity and allowed the expansion of ASP activities.

“By using this system, our daily ASP rounds and follow-up of recommendations have become more efficient, permitting us to cast a wider net to review more charts and thus intervene in more situations,” Katzman said.

Specifically, the system led to an increase in the number of charts reviewed from approximately 3,500 in 2014 to 6,600 in 2017, and in the number of charts that led to an ASP recommendation, from about 900 to more than 1,400 over the same time, the researchers reported.

“From a patient-centered perspective across our institution, our efforts have been associated with a continuing decrease in antimicrobial usage and concomitant decreases in antibiotic resistance and C. difficile infections,” Katzman said.

The researchers observed a net of 2,054 inpatient antimicrobial days of therapy avoided in the most recent year. Moreover, the rate of vancomycin resistance for Enterococcus isolates decreased from 23% in 2011 to 15% in 2018, they reported.

“The underlying goals of recording and tracking valid data for quality improvement purposes and to maintain support by hospital leadership are universal for any ASP,” Katzman said. “Further efforts will continue to optimize ways to identify, review and intervene in clinical situations where antimicrobial usage can be improved, such as the widespread overtreatment of asymptomatic bacteriuria. Adapting the principles and methods of stewardship (including the system described in our paper) to the outpatient setting and to partnering health care institutions are also important.” - by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.