title: A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.
abstract: BACKGROUND
  Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program.
  
  
  METHODS
  A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated.
  
  
  RESULTS
  After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy.
  
  
  CONCLUSIONS
  The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web-based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.
authors.affiliation: Divisions of Pediatric Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
authors.forename: Carlton K K
authors.initials: CK
authors.lastname: Lee
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Jain
authors.forename: Kara L
authors.initials: KL
authors.lastname: Murray
authors.forename: Jason
authors.initials: J
authors.lastname: Topolski
authors.forename: Robert E
authors.initials: RE
authors.lastname: Miller
authors.forename: Timothy
authors.initials: T
authors.lastname: Townsend
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Lehmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D015142:Baltimore; D003258:Consumer Behavior; D003365:Costs and Cost Analysis; D017723:Drug Utilization Review / Q000458:organization & administration; D006776:Hospitals, Pediatric / Q000191:economics; D006784:Hospitals, Teaching / Q000191:economics; D020407:Internet; D007902:Length of Stay; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents