Other specific DSP article suggested by Editorial Board
Reducing incorrect antibiotic dosing and enhancing prescriber adherence through a real-time, patient-specific clinical decision support system: A post-implementation evaluation.
DOI: 10.1002/bcp.70397
Authors: Liang SY, et al
Abstract
Aims: Incorrect antibiotic dosing remains common, particularly in patients with renal impairment or obesity, contributing to treatment failure and antimicrobial resistance. Although clinical decision support systems (CDSS) are increasingly used, few offer real-time, patient-specific dosing recommendations based on a curated antibiotic dosing database integrated directly into prescribing workflows, limiting the optimization of antimicrobial therapy.
Methods: A mandatory CDSS was implemented for restricted antibiotics at a 1100-bed tertiary hospital. The system automatically integrated renal function and body weight from the electronic medical record, along with prescriber-selected dialysis modality, to generate predefined, guideline-based dosing options tailored to individual clinical scenarios. Prescribers were required to either accept a recommended dose or provide justification for overriding it. 81 164 prescriptions were retrospectively analysed after implementation to assess CDSS-adherence and compared 41 550 pre- and 33 994 post-implementation prescriptions to evaluate dosing accuracy.
Results: CDSS-adherence increased from 62.2% to 92.6% during the post-implementation period, while the incorrect antibiotic dosing rate declined from 3.7% to 2.1% (P < 0.001). Among non-adherent prescriptions, 72.4% of manually entered doses were concordant with CDSS recommendations and were associated with a lower incorrect dosing rate than discordant overrides (0.5% vs. 9.7%; P < 0.001). Key system refinements, including support for inhaled colistin and agent-specific loading dose guidance, further improved usability and CDSS-adherence.
Conclusions: By integrating real-time, patient-specific parameters into the prescribing process and offering guideline-aligned recommendations, this CDSS significantly improved prescriber adherence and reduced incorrect antibiotic dosing. The system shows strong potential to improve medication safety and support antimicrobial stewardship.
Other specific DSP article suggested by Editorial Board
Assessing the implementation determinants of antimicrobial stewardship programmes in sub-Saharan Africa through the complexity lens. A CFIR-guided systematic review.
Authors: Kapatsa T, et al
Abstract
Background: Antimicrobial resistance (AMR) poses a significant threat in sub-Saharan Africa (SSA), where fragile health systems and under-resourced facilities exacerbate its burden. Antimicrobial stewardship (AMS) programs have been introduced as a key strategy to optimize antimicrobial use and curb AMR. However, the successful implementation of AMS in SSA remains limited. This systematic review assessed the implementation determinants of AMS programs in SSA using the Consolidated Framework for Implementation Research (CFIR).
Methods: A systematic search was conducted across PubMed and Google Scholar for articles published between 2018 and 2024, following PRISMA guidelines. Studies were included if they reported on factors influencing AMS implementation in SSA. Data from 31 eligible studies were extracted and mapped according to the CFIR framework’s five domains to identify key barriers and facilitators.
Results: Major implementation barriers in SSA included underfunded health systems, limited diagnostic and laboratory infrastructure, lack of context-specific AMS guidelines, weak governance and policy enforcement, and insufficient training of healthcare providers. Enablers included hospital leadership support, stakeholder engagement, and existing global frameworks such as the WHO AWaRe guidelines. The review found poor integration of AMS into national health priorities and limited surveillance data, especially at the primary care level.
Conclusion: AMS implementation in SSA is constrained by systemic, infrastructural, and educational challenges. Strengthening leadership, surveillance systems, healthcare worker training, and the development of context-specific AMS protocols are essential. Effective implementation will require tailored strategies grounded in local realities and supported by strong governance and sustainable funding mechanisms.
Other specific DSP article suggested by Editorial Board
Impact of a post-prescription audit and feedback antimicrobial stewardship intervention on inappropriate carbapenem prescribing: an interrupted time series analysis.
Authors: Sangiorgi F, et al
Abstract
Background: Antimicrobial stewardship programs (ASPs) are essential to improve antibiotic prescribing. This study evaluated the impact of a post-prescription audit and feedback intervention on carbapenem prescribing appropriateness in a large university hospital.
Methods: This retrospective observational study utilized interrupted time series (ITS) analysis, employing an Autoregressive Integrated Moving Average (ARIMA) model, to assess carbapenem prescribing across three consecutive phases: a 12-month pre-intervention, a 6-month intervention, and a 6-month post-intervention follow-up. Carbapenem prescribing appropriateness was retrospectively evaluated using an in-house developed algorithm, based on international and national guidelines and institutional protocols. The intervention involved bedside consultations by infectious diseases specialists employing a post-prescription audit with face-to-face feedback.
Results: 1825 carbapenem therapies were evaluated, primarily prescribed for suspected/confirmed bloodstream infections (46%, 843/1825). Among these, 458 (25%) were deemed inappropriate, mainly due to unnecessarily broad-spectrum use (72%, 331/458). The ITS-ARIMA model showed an immediate 11% reduction in the rate of inappropriate prescriptions during the first month of intervention phase (P = 0.001), followed by a non-significant downward trend during the remaining intervention period. However, an immediate 14.9% increase in inappropriate prescriptions was observed at the onset of the post-intervention phase (P = 0.001), indicating a rebound effect after the withdrawal of the active stewardship intervention.
Conclusions: Implementing a post-prescription audit and face-to-face feedback intervention was associated with a short-term improvement in carbapenem prescribing appropriateness. A reduction in the trend of inappropriateness was observed, although this change was not statistically significant. Future studies should investigate strategies for implementing sustainable ASPs optimizing human resources and time investment.