Indiana University School of Medicine, Pediatrics , Indianapolis, Indiana, United States.
Riley Hospital for Children at IU Health, Clinical Pharmacy , Indianapolis, Indiana, United States.
Appl Clin Inform. 2013 Nov 27;4(4):556-68. doi: 10.4338/ACI-2013-07-RA-0054. eCollection 2013.
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.
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.
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.
ASP content and workflow accounted for proportionally fewer incidents than expected as compared to equally complex and frequently used CPOE content.
Well-defined ASP recommendations and modular design strengthened successful CPOE implementation, as well as the adoption of specialized pediatric ASP expertise with other facilities.
抗菌药物管理计划（ASPs）有助于实现抗菌药物使用方面的质量和安全目标。在 CPOE 实施之前，我们儿科三级医院的 ASP 制定了一个包含优化剂量建议的纸质医嘱集。在将我们的 ASP 适应 CPOE 的过程中，我们旨在保持 ASP 建议的一致性，并将 ASP 专业知识扩展到我们医疗系统中的其他医院。
我们医疗系统中的 9 家医院采用了儿科 CPOE，并共享一个通用域（Cerner Millenium）。ASP 临床医生开发了六十个独立的电子医嘱集（供应商参考 PowerPlans），可单独使用或作为更大的电子医嘱集的一部分。分析 CPOE 实施期间报告的事件和药物差异报告，以确定 ASP 适应的效果。
在 CPOE 实施后的头 30 天内，共使用了 769 个独特的 PowerPlans，总计 15889 次。其中，43 个 PowerPlans 包含在 ASP 设计中，总共使用了 1149 次（所有医嘱的 7.2%）。在 CPOE 实施期间，记录了 437 个事件，其中 1.1%与 ASP 内容或工作流程有关。此外，对 CPOE 实施后药物差异的分析表明，ASP 错误占总药物差异的 2.9%。
与同样复杂且经常使用的 CPOE 内容相比，ASP 内容和工作流程引起的事件比例相对较低。
明确的 ASP 建议和模块化设计加强了 CPOE 的成功实施，以及在其他设施中采用专门的儿科 ASP 专业知识。
