A World Wide Web–Based Antimicrobial Stewardship Program Improves Efficiency, Communication, and User Satisfaction and Reduces Cost in a Tertiary Care Pediatric Medical Center

• Published in: Clinical infectious diseases 2008-09, Vol.47 (6), p.747-753
• Main Authors: Agwu, Allison L., Lee, Carlton K. K., Jain, Sanjay K., Murray, Kara L., Topolski, Jason, Miller, Robert E., Townsend, Timothy, Lehmann, Christoph U.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobials; Articles and Commentaries; Baltimore; Biological and medical sciences; Consumer Behavior; Cost efficiency; Cost savings; Costs and Cost Analysis; Dosage; Drug Utilization Review - organization & administration; Hospitals, Pediatric - economics; Hospitals, Teaching - economics; Infectious diseases; Internet; Length of Stay; Medical sciences; Pediatrics; Pharmacies; Pharmacists; Severity of Illness Index; Teaching hospitals; World Wide Web
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/591133

Background.Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web–based antimicrobial restriction program to address problems with the existing restriction program. Methods.A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web–based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. Results.After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P=.24). In addition, 40% fewer restricted antimicrobial–related phone calls were noted by the pharmacy. Conclusion.The World Wide Web–based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web–based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.