title: Effects of a computerized provider order entry and a clinical decision support system to improve cefazolin use in surgical prophylaxis: a cost saving analysis.
abstract: BACKGROUND
  Computerized Provider Order Entry (CPOE) and Clinical Decision Support System (CDSS) help practitioners to choose evidence-based decisions, regarding patients' needs. Despite its use in developed countries, in Brazil, the impact of a CPOE/CDSS to improve cefazolin use in surgical prophylaxis was not assessed yet.
  
  
  OBJECTIVE
  We aimed to evaluate the impact of a CDSS to improve the use of prophylactic cefazolin and to assess the cost savings associated to inappropriate prescribing.
  
  
  METHODS
  This is a cross-sectional study that compared two different scenarios: one prior CPOE/CDSS versus after software implementation. We conducted twelve years of data analysis (3 years prior and 9 years after CDSS implementation), where main outcomes from this study included: cefazolin Defined Daily Doses/100 bed-days (DDD), crude costs and product of costs-DDD (cost-DDD/100 bed-days). We applied a Spearman rho non-parametric test to assess the reduction of cefazolin consumption through the years.
  
  
  RESULTS
  In twelve years, 84,383 vials of cefazolin were dispensed and represented 38.89 DDD/100 bed-days or USD 44,722.99. Surgical wards were the largest drug prescribers and comprised >95% of our studied sample. While in 2002, there were 6.31 DDD/100 bed-days, 9 years later there was a reduction to 2.15 (p<0.05). In a scenario without CDSS, the hospital would have consumed 75.72 DDD/100 bed-days, which is equivalent to USD 116 998.07. It is estimated that CDSS provided USD 50,433.39 of cost savings.
  
  
  CONCLUSIONS
  The implementation of a CPOE/CDSS helped to improve prophylactic cefazolin use by reducing its consumption and estimated direct costs.
authors: Clinical Pharmacy Division, Porto Alegre Clinical Hospital. Porto Alegre, RS ( Brazil ). lucasokumura@yahoo.com.br.
authors: Lucas M
authors: 0000-0003-3607-619X
authors: LM
authors: Okumura
authors: Infection Control Service, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ). izelandia.veroneze@gmail.com.
authors: Izelandia
authors: I
authors: Veroneze
authors: Infection Control Service, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ). celiaburgardt@gmail.com.
authors: Celia I
authors: CI
authors: Burgardt
authors: Infection Control Service, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ). martafragoso@terra.com.br.
authors: Marta F
authors: MF
authors: Fragoso
keywords: Anti-Bacterial Agents; Brazil; Clinical; Clinical Pharmacy Information Systems; Cost Savings; Decision Support Systems; Hospitals; Medical Order Entry Systems; Pharmacists