Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part B Therapy
Chapter 9.6. Clinical Decision Support Systems
Adrienne Randolph, Anne Holbrook, Amit Garg, Brian Haynes, Pierre Durieux, Deborah J. Cook, Gordon Guyatt
Clinical Scenario
Topics Discussed:
antibiotics, clinical decision support systems, inappropriate drug prescribing, pediatrics
Excerpt:
"As director of a hospital-based pediatric outpatient clinic,
you oversee the care delivered by 45 pediatric residents and 5 nurse
practitioners. Last year, the hospital infection control audit of
charts in your clinic revealed that antibiotic use was inappropriate
for 47% of children presenting with respiratory symptoms
most likely of viral origin. They urged you to decrease the inappropriate
use of antibiotics in your clinic and set a target of a 50% reduction
throughout the next 12 months. Your response included education
of trainees on appropriate evidence-based antibiotic prescribing
during 4 lunches throughout the year, insistence that trainees complete
a relevant test administered in an online scenario-based format,
and reminders to attending physicians to carefully oversee resident
prescribing, emphasizing the need to decrease inappropriate antibiotic
use. You just received the results of this year's audit,
and it shows only a 2% decrease in the overall rate of
inappropriate antibiotic prescribing. In thinking about further
strategies that you need, you remember that all the residents now
have a handheld personal digital assistant (PDA) in preparation
for a computer-based order entry system. Could you use this tool
to more effectively decrease inappropriate antibiotic prescribing?..."
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