Infection Control & Hospital Epidemiology (2018), 39, 986–988 doi:10.1017/ice.2018.135
Concise Communication
Implementation of an institution-specific antimicrobial stewardship smartphone application
Heather L. Young MD1,2, Katherine C. Shihadeh PharmD2, Alisha A. Skinner MD2,4, Bryan C. Knepper MPH, MSc5, Jeffrey Sankoff MD2,6, Jeremy Voros MD7 and Timothy C. Jenkins MD1,2 1Division of Infectious Diseases and Department of Medicine, Denver Health Medical Center, Denver, Colorado, 2University of Colorado Hospital, Denver,
Colorado, 3Department of Pharmacy, Denver Health Medical Center, Denver, Colorado, 4Division of Hospitalist Medicine and Department of Medicine, Denver Health Medical Center, Denver, Colorado, 5Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado, 6Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado and 7Emergency Physicians Integrated Care, Salt Lake City Utah
Abstract
Smartphones are increasingly used to access clinical decision support, and many medical applications provide antimicrobial prescribing guidance. However, these applications do not account for local antibiotic resistance patterns and formularies. We implemented an institution-specific antimicrobial stewardship smartphone application and studied patterns of use over a 1-year period.
(Received 18 February 2018; accepted 12 May 2018; electronically published June 21, 2018)
The Centers for Disease Control and Prevention (CDC) recom- mends implementation of an antimicrobial stewardship (AS) pro- gram in all acute-care hospitals, nursing homes, and outpatient clinics.1–3 Because smartphones are increasingly used to access clinical decision support,4–6 several experts have explored smart- phones applications (apps) to disseminate antibiotic prescribing recommendations.7–10 As of 2012, more than 1,200 infectious diseases-focused apps were available, a number of which contain AS guidance on either a national or local level.9,10 While nationally focused AS apps tend to be more comprehensive, they do not account for local antibiotic resistance patterns and formularies. For these reasons, local AS-focused apps may be preferable. We developed and implemented an AS-focused app in August
2014; a second version was released in October 2016. The app contains local prescribing recommendations for >50 infections, perioperative antibiotic prophylaxis, antimicrobial dose adjust- ments based on renal function, and the annual antibiogram. The objective of this study was to determine patterns of app use over time and to explore the conditions for which providers most often seek prescribing resources.
Methods Setting and Population
This cross-sectional observational study was conducted at Denver Health, an integrated healthcare system consisting of a 500-bed safety-net teaching hospital, an emergency department, 2 urgent care centers, 9 primary care clinics, and 17 school-based health
Author for correspondence: Heather L. Young, MD, 601 Broadway, Denver CO 80204. E-mail:
heather.young2@
dhha.org
Cite this article: Young HL, et al. (2018). Implementation of an institution-specific
antimicrobial stewardship smartphone application. Infection Control & Hospital Epidemiology 2018, 39, 986–988. doi: 10.1017/S0899823X17001738
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
centers.11 In 2017, 477 physicians, 322 advanced practice providers, and 52 pharmacists were employed by Denver Health. Approxi- mately 1,000 residents and 2,500 students rotate through the healthcare system annually.
App Development and Dissemination
The app is a mobile website that functions as a native application on smartphones and tablets; it can also be accessed by computer. The display is identical on all 3 types of devices (Supplement A). It is available via an open-access URL and is not marketed in app stores. The clinical providers on the AS team update and add content on a rolling basis. The first app version was developed in 2014 by an emergency
medicine resident (J.V.). It was disseminated to emergency medi- cine providers via e-mail and word of mouth. While the original intent was to provide empiric antibiotic recommendations for common infections treated in the emergency department, the content quickly expanded to include conditions encountered by inpatient and primary care providers, too. The app was then dis- seminated system-wide to hospitalists, surgeons, primary care providers, advanced practice providers, and pharmacists via (1) e-mail with instructions to obtain the app; (2) an advertisement at departmental meetings and teaching conferences; (3) instructions posted on the AS internal website; (4) a one-on-one tutorial in clinical settings; and (5) education in the required annual infection prevention and AS training module. Once providers accessed the URL, they were encouraged to select either “bookmark” or “add to homescreen” for easy future access. The first 2 implementation techniques were solely focused on marketing of the app, while the latter 3 were opportunistic, promoting the app through pre-existing AS or infection prevention connections. While this app was anecdotally useful to providers, our information technology department could not support the app on
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