Clinical decision support in the electronic health record: a primer for antimicrobial stewards and infection preventionists: work smarter so end users don't work harder

Mary Rochelle Smith; Julie J Lee; Marisa Holubar; Jorge L Salinas; Mindy M Sampson; Richard J Medford; Amy Chang

doi:10.1017/ash.2024.448

Clinical decision support in the electronic health record: a primer for antimicrobial stewards and infection preventionists: work smarter so end users don't work harder

Antimicrob Steward Healthc Epidemiol. 2024 Nov 14;4(1):e204. doi: 10.1017/ash.2024.448. eCollection 2024.

Authors

Mary Rochelle Smith¹, Julie J Lee², Marisa Holubar¹, Jorge L Salinas¹, Mindy M Sampson¹, Richard J Medford³, Amy Chang¹

Affiliations

¹ Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
² Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA.
³ Division of Infectious Diseases & Geographic Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.

Abstract

Objective: Computerized clinical decision support (CDS) assists healthcare professionals in making decisions to improve patient care. In the realms of antimicrobial stewardship (ASP) and infection prevention (IP) programs, CDS interventions can play a crucial role in optimizing antibiotic prescribing practices, reducing healthcare-associated infections, and promoting diagnostic stewardship when optimally designed. This primer article aims to provide ASP and IP professionals with a practical framework for the development, design, and evaluation of CDS interventions.

Setting: Large academic medical center design: Established frameworks of CDS evaluation, "Five Rights" of CDS and the "Ten Commandments of Effective Clinical Decision Support", were applied to two real-world examples of CDS tools, a Vancomycin Best Practice Advisory and a Clostridioides Difficile order panel, to demonstrate a structured approach to developing and enhancing the functionality of ASP/IP CDS interventions to promote efficacy and reduce unintended consequences of CDS.

Conclusions: By outlining a structured approach for the development and evaluation of CDS interventions, with focus on end user engagement, efficiency and feasibility, ASP and IP professionals can leverage CDS to enhance IP/ASP quality improvement initiatives aimed to improve antibiotic utilization, diagnostic stewardship, and adherence to IP protocols.