Electronic medical record system may improve efforts to prevent antibiotic drug resistance

Adapting features of the electronic medical record system used by doctors in caring for their patients may improve efforts to prevent antibiotic drug resistance, according to Penn State research.

Physicians and pharmacists at Penn State College of Medicine collaborated with computer scientists to expand the work of the Antimicrobial Stewardship Program at Penn State Health Milton S. Hershey Medical Center.

According to Dr. Michael Katzman, professor of medicine in the division of infectious diseases and director of the program, the changes have allowed the pharmacists and physicians who monitor antibiotic use across the hospital to review more charts -; and it has enhanced the capabilities of the program.

Our efforts have been associated with continuing decreases in antibiotic usage, antibiotic resistance and C. difficile infections at our medical center. By using the documentation system we developed, our daily rounds have become more efficient and allowed us to assist more clinicians in optimizing antibiotic use where appropriate.

Dr. Michael Katzman, professor of medicine in the division of infectious diseases and director of the program

Preventing antibiotic-resistant infections

Katzman and his colleagues worked with information services and computer scientists to adapt the electronic medical record used at the Milton S. Hershey Medical Center. As a result of their collaboration, they created a system to track the work of the Antimicrobial Stewardship Program to help evaluate and follow up on antibiotic use for both adult and pediatric patients.

This system is just one of many steps taken by Hershey Medical Center to optimize the use of antibiotics. The primary goals of the program are to improve the care of individual patients so that they achieve better outcomes with fewer complications, prevent the development of resistance to antibiotics and decrease the incidence of C. difficile infections -; a known complication of overuse of antibiotics.

"The major reason we need to monitor antibiotic use is patient safety," said Katzman. According to the Centers for Disease Control and Prevention, a large percentage of antibiotic use is inappropriate. Katzman says such inappropriate use can lead to inadequate treatment, avoidable side effects, superinfections and increased resistance to antibiotics.

The Antimicrobial Stewardship Program at Hershey Medical Center began in 2011 and is directed by Katzman and pharmacist Cory Hale. Other core team members are Dr. George McSherry, professor of pediatrics, and pharmacist Mark Lesher. In 2018, the Infectious Diseases Society of America named Hershey Medical Center one of 25 Antimicrobial Stewardship Centers of Excellence – and results just published in Open Forum Infectious Diseases may indicate why.

According to Katzman, the documentation system they developed and the continued efforts of the Antimicrobial Stewardship Program have been associated with a 21% decrease in annual antimicrobial days of therapy since 2011. Additionally, certain bacterial infections showed diminished resistance to certain drugs and the rate of C. difficile infections decreased.

Conversation is key

Members of the Antimicrobial Stewardship Program work to review patient medical records and assess if antibiotic use is optimal for each patient. In cases where there may be an opportunity to improve the choice or dose of an antibiotic, or even to stop antibiotics, they initiate a conversation with the patient's doctor.

For Katzman, the key to the success of the program is working together with physicians to ensure patients are receiving the best treatment possible. The system they developed and describe in their study has made it easier for them to have discussions with patient providers about optimizing antibiotic use for their patients.

"Because we recognize that each patient is unique and respect the clinical judgment of the primary caregivers, more than 80% of our recommendations are accepted," Katzman said. "Ultimately, it's about making sure antibiotic use is optimal for each patient."

The authors received no funding support and declare no conflict of interest.