Development of Proactive Antimicrobial Drug Use Evaluation Using Information Systems: a Case Study of Surin Hospital

Abstract

A key strategy in successful Antimicrobial Stewardship Programs (ASP) is implementing a preauthorization system and/or combining it with prospective audit and feedback. Surin Hospital developed a proactive drug use evaluation system called “Proactive DUE” involving a multidisciplinary team on the wards. However, obstacles were encountered during the preparation of patient data for the review team due to the complexity and time-consuming nature of the process, leading to incomplete and inefficient proactive drug use evaluations. This study aimed to develop an efficient proactive antimicrobial drug use assessment by applying information systems for proactive drug use monitoring. This study followed an action research methodology divided into three phases: Phase 1 involved examining the issues with the current Proactive DUE. Significant problems included lengthy preparation times and incomplete data. Phase 2 involved addressing these issues by creating an automated data extraction system called “Ready-to-Use DUE Form.” Phase 3 assessed the outcomes of the implementation, including the time and accuracy of data collection, and the comprehensiveness of drug use monitoring and assessment. The results showed a significant reduction in data collection time from 11 minutes 6 seconds per case to 36 seconds per case. Data accuracy increased significantly from 35.42% to 91.67%. The new system increased the coverage of drug use monitoring from 45.84% to 90.34% of patients receiving nine controlled antibiotics. The rate of antibiotic de-escalation increased from 19.48% to 33.23%, and the rate of drug discontinuation due to completed duration increased from 5.49% to 9.42%, both significantly. The amount of controlled antibiotic use, measured in Defined Daily Dose (DDD) per 100 bed-days, decreased by 22.47%. This study demonstrates the benefits of developing information systems for proactive drug use evaluation, resulting in effective control and management of antibiotic use.