Jenkins J A, Pontefract S K, Cresswell K, Williams R, Sheikh A, Coleman J J
University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK.
Usher Institute, The University of Edinburgh, Edinburgh, EH16 4UX, UK.
JAC Antimicrob Resist. 2022 Jun 28;4(3):dlac063. doi: 10.1093/jacamr/dlac063. eCollection 2022 Jun.
To identify interventions implemented in hospital electronic prescribing systems and the outcome measures used to monitor their impact.
We systematically searched CINAHL, EMBASE, Google Scholar and Medline using keywords in three strands: (i) population: hospital inpatient or emergency department; (ii) intervention: electronic prescribing functionality; and (iii) outcome: antimicrobial stewardship. The interventions were grouped into six themes: alerts, order sets, restriction of access, mandated documentation, embedded guidelines and automatic prescription stop. The outcome measures were organized into those that measure the quality or quantity of prescribing or clinical decision support (CDS) activity. The impact of each intervention reported was grouped into a positive, negative or no change.
A total of 28 studies were eligible for inclusion. There were 28 different interventions grouped into the six themes. Alerts visible to the practitioner in the electronic health record (EHR) were most frequently implemented (= 11/28). Twenty different outcome measures were identified, divided into quality (= 13/20) and quantity outcomes (= 4/20) and CDS activity (= 3/20). One-third of outcomes reported across the 28 studies showed positive change (34.4%, = 42/122) and 61.4% (= 75/122) showed no change.
The most frequently implemented interventions were alerts, the majority of which were to influence behaviour or decision-making of the practitioner within the EHR. Quality outcomes were most frequently selected by researchers. The review supports previous research that larger well-designed randomized studies are needed to investigate the impact of interventions on AMS and outcome measures to be standardized.
确定医院电子处方系统中实施的干预措施以及用于监测其影响的结果指标。
我们使用三个方面的关键词系统检索了CINAHL、EMBASE、谷歌学术和Medline：（i）人群：医院住院患者或急诊科患者；（ii）干预措施：电子处方功能；（iii）结果：抗菌药物管理。干预措施分为六个主题：警报、医嘱集、访问限制、强制记录、嵌入式指南和自动处方停用。结果指标分为衡量处方质量或数量或临床决策支持（CDS）活动的指标。所报告的每项干预措施的影响分为积极、消极或无变化。
共有28项研究符合纳入标准。有28种不同的干预措施分为六个主题。电子健康记录（EHR）中对从业者可见的警报是最常实施的（=11/28）。确定了20种不同的结果指标，分为质量指标（=13/20）、数量指标（=4/20）和CDS活动指标（=3/20）。28项研究报告的结果中，三分之一显示出积极变化（34.4%，=42/122），61.4%（=75/122）显示无变化。
最常实施的干预措施是警报，其中大多数是为了影响EHR中从业者的行为或决策。质量指标是研究人员最常选择的。该综述支持先前的研究，即需要进行更大规模、设计良好的随机研究来调查干预措施对抗菌药物管理的影响，并使结果指标标准化。
