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Grant # R21 NR010823 Title: ELECTRONIC COMMUNICATION FOR ANTIMICROBIAL MANAGEMENT (ECAM) PI: Leanne Currie, RN, DNSc, Assistant Professor of Nursing, Columbia University School of Nursing Funder: National Institute of Nursing Research, National Institutes of Health Dates: 9/13/07 - 5/31/10 Funding: $442,750 The goal of this study is to improve the appropriate and judicious use of antibiotics in the neonatal intensive care unit by developing and testing an automated method to remind clinicians to stop or change inappropriate antibiotics. |
| Project Summary | Research Team |
PROJECT SUMMARY
Inappropriate antibiotic prescribing patterns of clinicians continue to contribute to the global problem of antimicrobial resistance. The goal of this study, Electronic Communication for Antimicrobial Management (ECAM), is to improve the appropriate and judicious use of antibiotics in the neonatal intensive care unit (NICU) by developing and testing an automated method to remind clinicians to stop or change inappropriate antibiotics. The method will provide clinical decision support (CDS) within a computerized provider order entry (CPOE) system. Specific aims of ECAM are to: (1) define the data elements, logic, timing and method for clinical decision support for antibiotic prescribing within the workflow of the NICU and to implement the prototype CDS-CPOE system; (2) evaluate the CDS-CPOE system for violation of usability principles and to evaluate perceived usefulness, ease of use and intention to use the CDS-CPOE for antibiotic prescribing in two NICUs; and (3) examine the relationships between end-user characteristics and perceived usefulness, perceived ease of use and intention to use the CDS-CPOE for antibiotic prescribing in two NICUs.
Despite the movement towards use of CDS and CPOE systems and the growing use of computers in healthcare, the use of CDS for antimicrobial management withina CPOE system has not been studied extensively. The Centers for Disease Control and Prevention has released a 12-step program to prevent antimicrobial resistance. Recommendations related to prescriber behavior that are particularly well suited to receive computerized CDS include: 1) target the pathogen; 2) use local data; 3) know when to say NO (e.g., to vancomycin); and 4) stop treatment when infection is cured or unlikely. The ECAM study will target these steps by identifying relevant data and defining the logic, timing and method for decision support for antibiotic prescribing within CPOE and within the prescribers’ workflow.
The System Development Life Cycle, a six phase process that uses continuous feedback from key individuals to guide the computer programming and design decisions, serves as the framework for this project. We will use ethnographic, qualitative and descriptive research methods to develop, test and evaluate the perceived ease of use and usefulness of a prototype CDS-CPOE for antibiotic prescribing in two randomly assigned NICUs which are part of Dr. Saiman’s R01, a quasi-experimental clinical trial being proposed in our Center for Interdisciplinary Research to Reduce Antimicrobial Resistance, CIRAR. We hypothesize that providing decision support that targets the CDC 12-steps for antimicrobial management may improve prescribing practice and thus may help to reduce antimicrobial resistance.
RESEARCH TEAM
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| Name | Role | Institution / Department |
| Leanne Currie, RN, DNSc Assistant Professor of Nursing |
Principal Investigator | Columbia University School of Nursing |
| Philip Graham III, MD Assistant Professor of Pediatrics |
Co-Investigator | Department of Pediatrics, College of Physicians & Surgeons of Columbia University |
| Adam Wilcox, PhD Assistant Professor of Biomedical Informatics |
Co-Investigator | Department of Biomedical Informatics, Columbia University |
| Peter Stetson, MD, MA Assistant Professor of Clinical Medicine and Clinical Biomedical Informatics |
Co-Investigator | Department of Medicine and Department of Biomedical Informatics, Columbia University |
| Barbara Sheehan | Project Director | Columbia University School of Nursing |