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Saturday, March 20, 2010: 2:00 PM
International North (Hyatt Regency Atlanta)
Early Experience with the Statewide Rollout of a Computerized Antimicrobial Approval System
Background: The optimal strategy for improving antimicrobial use in the hospital setting is unknown. Computerized stewardship systems show promise, but their successful uptake depends on adequate preparation and support. In 2 states ofAustralia the state government offered to pay for a computerized stewardship system called Guidance DS for all public hospitals. This system has a restricted drug approval system, access to guidelines, and auditing capability.
Objective: To describe the issues faced in the implementation of Guidance DS in the public hospitals of Victoria andTasmania
Methods: Each hospital that elected to adopt the system fashioned their own implementation strategy, with some assistance provided by a central team. Key informants were then asked to provide their perspectives on the barriers and facilitators to this process.
Results: Nine hospital networks in Victoria and 1 network in Tasmania chose to adopt Guidance DS with a stepwise deployment since 2007.The program has been implemented in seven networks to date. Project officers described no difficulties with the technology. Ease of uptake was related to the hospital’s existing stewardship program. Some hospitals without an active existing stewardship program met with resistance from other clinicians and needed to work harder to gain their confidence. Smaller hospitals required a structure to formally link them to larger hospitals for infectious diseases clinical support. Some informants described problems related to staff and resources. While the Victorian government paid for the software, no funding was provided for clinician or pharmacist’s time.Tasmania , in contrast employed dedicated staff to oversee the implementation. These staff helped to customize content, set up committees to audit activity, and provided rapid post approval review of patients on a daily basis. The Tasmanian implementation represented one of the more successful deployments, piloting the computerized antimicrobial stewardship system within the major tertiary referral hospital in the state with a planned future rollout across the other public hospitals.
Conclusions: Successful implementation of computerized antimicrobial stewardship systems depends on more than the tool alone. This multisite project illustrates the differences between hospitals and the way in which resources and careful planning are required to support such a system. The Tasmanian experience may act as a guide for other sites.
Background: The optimal strategy for improving antimicrobial use in the hospital setting is unknown. Computerized stewardship systems show promise, but their successful uptake depends on adequate preparation and support. In 2 states of
Objective: To describe the issues faced in the implementation of Guidance DS in the public hospitals of Victoria and
Methods: Each hospital that elected to adopt the system fashioned their own implementation strategy, with some assistance provided by a central team. Key informants were then asked to provide their perspectives on the barriers and facilitators to this process.
Results: Nine hospital networks in Victoria and 1 network in Tasmania chose to adopt Guidance DS with a stepwise deployment since 2007.The program has been implemented in seven networks to date. Project officers described no difficulties with the technology. Ease of uptake was related to the hospital’s existing stewardship program. Some hospitals without an active existing stewardship program met with resistance from other clinicians and needed to work harder to gain their confidence. Smaller hospitals required a structure to formally link them to larger hospitals for infectious diseases clinical support. Some informants described problems related to staff and resources. While the Victorian government paid for the software, no funding was provided for clinician or pharmacist’s time.
Conclusions: Successful implementation of computerized antimicrobial stewardship systems depends on more than the tool alone. This multisite project illustrates the differences between hospitals and the way in which resources and careful planning are required to support such a system. The Tasmanian experience may act as a guide for other sites.
Karin A Thursky MBBS FRACP MD, Susan B Luu B Pharm, Marion B Robertson B Pharm, Tara Anderson MBBS FRACP FRCPA, Duncan McKenzie B Pharm, Michael J Richards MBBS FRACP MD, Kirsty L Buising MBBS FRACP MD MPH
- Victorian Infectious Diseases Service, Royal Melbourne Hospital; 2. Royal Hobart Hospital,