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In the Hand of Our Clinicians

Hunter New England Local Health District
Project Added:
15 December 2014
Last updated:
17 December 2014

Summary

A mobile phone viewable website allows clinicians ready access to assist in the safe, appropriate and timely prescribing of antimicrobials, thus decreasing the risk of healthcare associated bloodstream infections. The move from paper-based resources has allowed for greater version control and provided opportunity for engagement with hard to reach groups e.g. rural general practitioners (GPs)/visiting medical officers (VMOs) and clinicians on-call to assist in the safe and appropriate prescribing of antimicrobials - decreasing the risk of healthcare associated bloodstream infections. 

This project was a finalist in the Harry Collins category of the 2014 NSW Health Awards. Download a poster from the 2014 NSW Health Awards.

Visit the Quality Use of Medicines website.

Aim 

The project aimed to use available technology to provide current, easily accessible, antimicrobial prescribing decision support information for clinicians to decrease Healthcare Associated Infections (HAIs).

Benefits

  • Improved infection control
  • Decreasing risk of HAIs.

Project Status

Sustained: the project has been implemented, is sustained in standard business. 

Background

The emergence of antimicrobial resistant bacteria, such as methicillin resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and increased infections with Clostridium difficile and multi-resistant Gram-negative bacteria, is of major concern to world societies. 

Existing Hunter New England (HNE) Antimicrobial Guidelines provided an underpinning framework for appropriate antimicrobial use. However the current process for updating and disseminating antimicrobial prescribing recommendations was inadequate, with insufficient access for clinicians and limited version control.

Extensive treatment guidelines were available through the HNE intranet directory, but how frequently these were referred to by clinicians at the coalface was doubtful. 

During 2012, John Hunter Hospital Pharmacy distributed 1500 antimicrobial lanyard cards across HNELHD.

Clinicians were valuing the availability of treatment guidelines in this format. The need for district-wide immediate access to updated antimicrobial management guidelines, regardless of location and desktop access became apparent when gentamicin dosing was changed for empiric sepsis treatment. The limitations of hard copy information were obvious.

Implementation

Smartphones provide an opportunity for greater engagement with hard to reach groups such as rural GPs/VMOs and clinicians on-call and also appealed to the 'digital generation' junior medical, pharmacy and nursing workforce.

A 2012 survey of the junior medical officer (JMO) prevocational workforce found that whilst 100% owned a smartphone, 30% were android and any program would require multiple platform access. The development team were engaged and developed the website to be accessible from android and iPhone mobile phones and desktop computers. 

The move from paper-based resources allowed for greater version control and provided to assist in the safe and appropriate prescribing of antimicrobials, thus decreasing the risk of healthcare associated bloodstream infections.

The website’s availability is now included in all Infectious Diseases documentation and presentations to clinicians within the LHD

There is strong governance around guidelines and antimicrobial stewardship to support the ongoing success of the website. Inclusion in JMO orientation will continue annually, with additional sessions on stewardship provided throughout the year.

Successful stewardship programs have been implemented within HNELHD which aim to optimise individual patient care while minimising the development and spread of antibiotic resistant microorganisms. Compliance with guidelines is a major component of this.

Results

Engagement with the HNE Quality Use of Medicines website has seen more than 1600 page views within the first four months of operation.

Usage data will be monitored and interventions undertaken to ensure ongoing uptake. A recent presentation at the National Prescribing Service Conference, resulted in numerous enquiries from sites across Australia.

The project is currently being rolled out to Drug and Therepeutics Committees and pharmacies across HNE.

Opportunities to expand the website content are unlimited with Surgical Antibiotic Prophylaxis and the list of restricted antimicrobials and their approved indications to be added soon.

The newer web technologies, including HTML5, CSS3 and JQuery, have substantially changed the access and “user friendliness” of websites and are especially important for small form factor applications. The project has the capacity to expand and, most importantly, update quickly. Its use is not limited to antimicrobial guidelines but could even include local resistance patterns (antibiograms) or site specific antimicrobial usage data.

This project has improved clinician access to guidelines which help the prevention and treatment of health associated infections. Translating this improved access into better patient outcome measures is difficult. Clinician awareness and engagement with the website provide the main measures of uptake.

Google Analytics has provided some interesting data with regard to the website’s use. Most views of the website were for 1 minute duration or less. Clinicians are wanting quick accurate access to information, which answers specific clinical requirements, whether it be therapeutic options, drug doses or monitoring guidance.

The use of the website at the desktop also supports this as the easy to use and directed information is able to be accessed quickly regardless of location. Tablet use is also encouraging as the implementation of wifi within facilities will see increased tablet use, supporting improved clinician.

Lessons Learnt

  • Multidisciplinary input during the development phase was most important. 
  • Surveys assessed usability and demand. 
  • Strong guideline and antimicrobial stewardship governance is in place to support the ongoing success of the website.
  • Inclusion in JMO education program will continue.  
  • The project has worked for greater engagement with hard to reach groups (e.g. rural GPs/VMOs) through regional Drug and Therapeutics Committees.

Contact 

Paula Doherty
Quality Use of Medicines Pharmacist
Hunter New England Local Health District
Phone: 02 4922 3585
Email: Paula.Doherty@hnehealth.nsw.gov.au

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