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Clinical Decision Support for Infection Prevention: Enhancing the Interactive Relationship between Technology, the IP, and the Patient

Posted on 09/22/15

antimicrobialstewardshipprogramoutcomesClinical decision support (CDS) systems provide a form of technology that is designed to deliver clinical knowledge that has been intelligently filtered by computer-generated rules in conjunction with best practice guidelines to providers of patient care. Wright and Robicsek1 state that “an essential element of an effective CDS system resides in the ability of the end user to immediately act on the information provided.”

In their paper on CDS for infection prevention, the authors cite an example of a surveillance system that notified infection preventionists (IPs) in real time about patient results that warranted the initiation of isolation precautions. Although the placement of alert-based information in a queue for review when convenient to the IP is decision support, an optimal workflow would include interoperability with the computerized order entry system to push out an isolation order.

Quan and colleagues2 created such a system for multidrug-resistant organisms (MDROs), including C. difficile, which monitored microbiology results and initiated a chart-based flag for positive results, ordered contact precautions on admission for patients with a MDRO flag, and displayed discontinuation criteria for patients with an active flag when providers attempted to discontinue an isolation order (see figure below).

clinicalonesource-ip-sept2015

In light of the mandated state and national reporting of MDROs and MDRO tracking for assessment of antimicrobial stewardship initiatives, automated systems that integrate microbiology results, registration data and physician ordering can significantly reduce the resource effort of IPs. These authors report an estimated 43 hours of infection prevention time per 1,000 admissions saved, the bulk of time related to the daily review of positive microbiology results.

As the availability of electronic health data increases, CDS systems for infection prevention can be leveraged to reduce infection prevention surveillance time and most importantly, contribute to patient safety through promotion of evidence-based practices and provision of clinical content to the end user.

1 Wright MO, Robicsek A. Clinical Decision Support Systems and Infection Prevention: To know is not enough. Am J Infect Control (43)2015:554-8.

2Quan KA, Cousins SM, Porter DD, Puppo RA, Huang SS. Automated tracking and ordering of precautions for multidrug-resistant organisms. Am J Infect Control (43)2015:577-80.

Topics: Infection Prevention

About the Author

Joan N. Hebden, RN, MS, CIC served as the Director of Infection Prevention and Control for 28 years at the University of Maryland Medical Center, Baltimore, MD. Her clinical background includes general medicine, oncology, and cardiothoracic intensive care. She has presented at national epidemiology conferences, participated in research regarding the transmission of multi-drug resistant bacteria, contributed chapters on infection control to nursing resource textbooks, and published in medical and infection control journals. Joan received her Bachelor of Science degree in nursing and a Master of Science degree in nursing education and trauma/critical care from the University of Maryland School of Nursing. She is certified in Infection Control & Epidemiology (CIC). Joan is an active member of SHEA and APIC and is currently on the Editorial Board of the American Journal of Infection Control (AJIC).