Conversion of a single-facility pediatric antimicrobial stewardship program to multi-facility application with computerized provider order entry and clinical decision support.
OBJECTIVE
Antimicrobial stewardship programs (ASPs) help meet quality and safety goals with regard to antimicrobial use. Prior to CPOE implementation, the ASP at our pediatric tertiary hospital developed a paper-based order set containing recommendations for optimization of dosing. In adapting our ASP for CPOE, we aimed to preserve consistency in our ASP recommendations and expand ASP expertise to other hospitals in our health system.


METHODS
Nine hospitals in our health system adopted pediatric CPOE and share a common domain (Cerner Millenium). ASP clinicians developed sixty individual electronic order sets (vendor reference PowerPlans) to be used independently or as part of larger electronic order sets. Analysis of incidents reported during CPOE implementation and medication variances reports was used to determine the effectiveness of the ASP adaptation.


RESULTS
769 unique PowerPlans were used 15,889 times in the first 30 days after CPOE implementation. Of these, 43 were PowerPlans included in the ASP design and were used a total of 1149 times (7.2% of all orders). During CPOE implementation, 437 incidents were documented, 1.1% of which were associated with ASP content or workflow. Additionally, analysis of medication variance following CPOE implementation showed that ASP errors accounted for 2.9% of total medication variances.


CONCLUSIONS
ASP content and workflow accounted for proportionally fewer incidents than expected as compared to equally complex and frequently used CPOE content.


CONCLUSIONS
Well-defined ASP recommendations and modular design strengthened successful CPOE implementation, as well as the adoption of specialized pediatric ASP expertise with other facilities.
Indiana University School of Medicine, Pediatrics , Indianapolis, Indiana, United States.
E C
EC
Webber
Riley Hospital for Children at IU Health, Clinical Pharmacy , Indianapolis, Indiana, United States.
H M
HM
Warhurst
Indiana University Health, Pharmacy Clinical Informatics , Indianapolis, Indiana, United States.
S S
SS
Smith
Indiana University School of Medicine, Pediatrics , Indianapolis, Indiana, United States.
E G
EG
Cox
Riley Hospital for Children at IU Health, Clinical Pharmacy , Indianapolis, Indiana, United States.
A S
AS
Crumby
Riley Hospital for Children at IU Health, Clinical Pharmacy , Indianapolis, Indiana, United States.
K R
KR
Nichols
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D020000:Decision Support Systems, Clinical; D006268:Health Facilities; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000706:statistics & numerical data; D010372:Pediatrics; D010595:Pharmacists; D010820:Physicians; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D063128:Tertiary Health Care / Q000706:statistics & numerical data
D000890:Anti-Infective Agents
Medical order entry system; clinical decision support systems; clinical pharmacy information systems; workflow