The development and impact of a pediatric antiinfective decision support tool

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Title The development and impact of a pediatric antiinfective decision support tool
Publication Type dissertation
School or College School of Medicine
Department Biomedical Informatics
Author Mullett, Charles J.
Contributor Daly, Judy; Korgenski, Kent
Date 2001-05
Description Computerized medical decision support tools have been shown to improve the quality of care and have been cited as one method to reduce pharmaceutical errors by the Institute of Medicine. An existing adult antiinfective decision support tool was enhanced by adding medical logic to make it appropriate for pediatric patients. Pediatric modifications to the medical logic and new antiinfective and dosage recommendations were implemented into the decision support tool. Measurements of appropriate antiinfective use, antiinfective costs, the rate of adverse drug events secondary to antiinfectives, antimicrobial-bacterial susceptibility mismatches, and pharmacy staff interventions for antiinfective agents were prospectively monitored during a six-month control and a six-month intervention period. Mandatory use of the decision support tool was initiated for all antiinfective orders in a 26-bed pediatric intensive (PICU) during the intervention period. Clinician opinions of the decision support tool were surveyed at the end of the intervention period. The patient populations during both the control period (n = 809) and the intervention period (n = 949) were similar with respect to their PICU and hospital lengths of stay, severity of illness, risk of mortality, and total hospital costs. The intervention group was significantly younger (5.5 years vs. 6.2 years, p < 0.05), and a greater percentage were treated with antibiotics (66.5 percent vs. 60.2 percent, p < 0.01). There was not a significant difference in type of antiinfectives ordered, or the number of antiinfectives, or antiinfective doses. Neither was there a difference in the rate of adverse drug events, or antibiotic-bacterial susceptibility mismatches. However, the rate of pharmacy interventions on erroneous drug doses declined by 59 percent from 35.5 to 14.5 interventions per 1000 patient-antiinfective courses (p < 0.01). The rate of antiinfective subtherapeutic patient days decreased by 36 percent from 7.4 to 4.7 subtherapeutic days per 100 patient days (p< 0.0001), and the rate of excessive-dose days declined by 28 percent from 8.5 to 6.1 excessive-dose days per 100 patient days (p < 0.0001). Additionally, the number of orders placed per antibiotic course decreased 11.5 percent from an average of 1.56 to 1.38 orders/pt-antiinfective (p < 0.01), and the robust estimate of the antiinfective costs per patient decreased 9 percent from $86.60 to $78.43 (p < 0.05). These data are supported by the surveyed clinicians who cited the dosage calculation assistance to be most helpful, and reported the program improved their antiinfective agent choices, increased their awareness of impairments in renal function, and reduced the likelihood of adverse drug events. Use of the pediatric antiinfective decision support tool in a PICU was considered beneficial to patient care by the clinicians, and positively impacted the rates of erroneous drug orders and antiinfective sub- and supratherapeutic risk-days.
Type Text
Publisher University of Utah
Subject Pediatrics; Medical Informatics
Subject MESH Pharmacies; Medical Errors; Automatic Data Processing
Dissertation Institution University of Utah
Dissertation Name PhD
Language eng
Relation is Version of Digital reproduction of "The development and impact of a pediatric antiinfective decision support tool.." Spencer S. Eccles Health Sciences Library. Print version of "The development and impact of a pediatric antiinfective decision support tool.." available at J. Willard Marriott Library Special Collection. RS43.5 2001 .M84
Rights Management © Charles J. Mullett.
Format application/pdf
Format Medium application/pdf
Format Extent 2,428,129 bytes
Identifier undthes,5290
Source Original: University of Utah Spencer S. Eccles Health Sciences Library (no longer available).
Funding/Fellowship Intermountain Health Care Corporatoin, the University of Utah, and the National Library of Medicine (NLM). NLM fellowship traing grant.
Master File Extent 2,428,183 bytes
ARK ark:/87278/s62r3tjz
Setname ir_etd
ID 191837
Reference URL https://collections.lib.utah.edu/ark:/87278/s62r3tjz
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