title: Developing clinical decision support within a commercial electronic health record system to improve antimicrobial prescribing in the neonatal ICU.
abstract: OBJECTIVE
  To develop and implement a clinical decision support (CDS) tool to improve antibiotic prescribing in neonatal intensive care units (NICUs) and to evaluate user acceptance of the CDS tool.
  
  
  METHODS
  Following sociotechnical analysis of NICU prescribing processes, a CDS tool for empiric and targeted antimicrobial therapy for healthcare-associated infections (HAIs) was developed and incorporated into a commercial electronic health record (EHR) in two NICUs. User logs were reviewed and NICU prescribers were surveyed for their perceptions of the CDS tool.
  
  
  RESULTS
  The CDS tool aggregated selected laboratory results, including culture results, to make treatment recommendations for common clinical scenarios. From July 2010 to May 2012, 1,303 CDS activations for 452 patients occurred representing 22% of patients prescribed antibiotics during this period. While NICU clinicians viewed two culture results per tool activation, prescribing recommendations were viewed during only 15% of activations. Most (63%) survey respondents were aware of the CDS tool, but fewer (37%) used it during their most recent NICU rotation. Respondents considered the most useful features to be summarized culture results (43%) and antibiotic recommendations (48%).
  
  
  CONCLUSIONS
  During the study period, the CDS tool functionality was hindered by EHR upgrades, implementation of a new laboratory information system, and changes to antimicrobial testing methodologies. Loss of functionality may have reduced viewing antibiotic recommendations. In contrast, viewing culture results was frequently performed, likely because this feature was perceived as useful and functionality was preserved.
  
  
  CONCLUSIONS
  To improve CDS tool visibility and usefulness, we recommend early user and information technology team involvement which would facilitate use and mitigate implementation challenges.
authors.affiliation: Department of Pediatrics, Columbia University , NY, NY.
authors.forename: R S
authors.initials: RS
authors.lastname: Hum
authors.affiliation: School of Nursing, Columbia University , NY, NY.
authors.forename: K
authors.initials: K
authors.lastname: Cato
authors.affiliation: Faculty Practice Organization, Columbia University , NY, NY.
authors.forename: B
authors.initials: B
authors.lastname: Sheehan
authors.affiliation: Department of Pediatrics, Northwestern University , Chicago, IL.
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Columbia University , NY, NY.
authors.forename: J
authors.initials: J
authors.lastname: Duchon
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College , NY, NY.
authors.forename: P
authors.initials: P
authors.lastname: DeLaMora
authors.affiliation: School of Nursing, Columbia University , NY, NY.
authors.forename: Y H
authors.initials: YH
authors.lastname: Ferng
authors.affiliation: Department of Pediatrics, Columbia University , NY, NY ; Department of Quality and Patient Safety, NewYork-Presbyterian Hospital , NY, NY ; Department of Infection Prevention & Control, NewYork-Presbyterian Hospital , NY, NY.
authors.forename: P
authors.initials: P
authors.lastname: Graham
authors.affiliation: Department of Biomedical Informatics, Columbia University , NY, NY.
authors.forename: D K
authors.initials: DK
authors.lastname: Vawdrey
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College , NY, NY.
authors.forename: J
authors.initials: J
authors.lastname: Perlman
authors.affiliation: School of Nursing, Columbia University , NY, NY ; School of Nursing and Mailman School of Public Health, Columbia University , NY, NY.
authors.forename: E
authors.initials: E
authors.lastname: Larson
authors.affiliation: Department of Pediatrics, Columbia University , NY, NY ; Department of Infection Prevention & Control, NewYork-Presbyterian Hospital , NY, NY.
authors.forename: L
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003625:Data Collection; D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions; D057286:Electronic Health Records; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D010549:Personal Satisfaction
chemical_list: D000890:Anti-Infective Agents
keywords: Antimicrobial stewardship; clinical decision support; implementation; neonatal intensive care unit