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. 2022 May 10;22(1):127.
doi: 10.1186/s12911-022-01860-3.

The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing

H Akhloufi  1   2 , H van der Sijs  3 , D C Melles  4 , C P van der Hoeven  4 , M Vogel  4 , J W Mouton  4 , A Verbon  4   5
Affiliations

The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing

H Akhloufi et al. BMC Med Inform Decis Mak. .

Abstract

Background: To describe and evaluate a clinical decision support system (CDSS) for empirical antibiotic therapy using a systematic framework.

Methods: A reporting framework for behavior change intervention implementation was used, which includes several domains: development, evaluation and implementation. Within the development domain a description is given of the engagement of stakeholders, a rationale for how the CDSS may influence antibiotic prescribing and a detailed outline of how the system was developed. Within the evaluation domain a technical validation is performed and the interaction between potential users and the CDSS is analyzed. Within the domain of implementation a description is given on how the CDSS was tested in the real world and the strategies that were used for implementation and adoption of the CDSS.

Results: Development: a CDSS was developed, with the involvement of stakeholders, to assist empirical antibiotic prescribing by physicians.

Evaluation: Technical problems were determined during the validation process and corrected in a new CDSS version. A usability study was performed to assess problems in the system-user interaction.

Implementation: In 114 patients the antibiotic advice that was generated by the CDSS was followed. For 54 patients the recommendations were not adhered to.

Conclusions: This study describes the development and validation of a CDSS for empirical antibiotic therapy and shows the usefulness of the systematic framework for reporting CDSS interventions. In addition it shows that CDSS recommendations are not always adhered to which is associated with incorrect use of the system.

Keywords: Antibacterial; Antibiotic stewardship; Clinical decision support system; Reporting framework.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Part of the flowchart developed for the working diagnosis pneumonia. For the complete flowchart of high and moderate risk community acquired pneumonia see Additional file 1: Figure S1. HAP is hospital acquired pneumonia. Risk level was assessed using the CURB-65 score
Fig. 2
Fig. 2
The flowchart for ciprofloxacin iv with all relevant information that the CDSS takes into account
Fig. 3
Fig. 3
The clinical decision support system for empirical antibiotic therapy for pneumonia. HAP is hospital acquired pneumonia. CAP is community acquired pneumonia. Patient data are not from an existing patient
Fig. 4
Fig. 4
Use of the CDSS and adoption of its recommendations
See this image and copyright information in PMC

References

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