Impacts of Technology Innovations on Antibiotic Stewardship

Healthcare providers have been adjusting to the delivery of care brought by the digital age. Not to mention, providers end up practicing in an intricate setting using advanced healthcare interventions to encourage patient safety, care quality and budget costs. To control this growing matter, the U. S. government advocated the use of Health information technology (HIT) as the key component for improved and affordable care, indorsing healthy communities while trying to deliver care to the interdisciplinary members of the team (McBride & Tietze, 2019). Numerous mandates like the Patient Protection and Affordable ­ Care Act which fosters HIT to ensure transparency, efficiency and engaging the people to successfully handle the cost and quality of care in the United States and the Health Information Technology for Economic and Clinical Health (HITECH) Act which helps healthcare clinicians to meet the meaningful use of electronic health records (EHRs). Consequently, healthcare facilities including hospitals and clinics had to use technology in communicating information (McBride & Tietze, 2018).

These are the advantages of using EHRs or patient portal

1. Add and update health information
   • Past medical history to update active or resolved medical conditions
   • Surgical history
   • Allergies and medications to guarantee patient safety and avoid unnecessary medication administration
2. To view diagnostic test results, medical imaging and clinicians’ notes
3. Healthcare providers can gather records from a different organization with the permission of the patient or the medical power of attorney to merge existing files to the previous ones and determine suitable care for the patient.
4. Patient and family education can be handed over or can be accessed via the patient portal.

Barriers to the implementation of EHRs

1. Computer illiteracy and computer anxiety – Some of our elderly population have little access to technology. They may suffer from cognitive and functional disabilities which may deter from learning a new skill.
2. Level of education and language barrier – this technology may have patient education that would not be suitable for a patient’s level of education and may not be understandable for people who are not fluent in the English language (McBride & Tietze, 2018).
3. Computer dependency – When computer downtime happens, healthcare workers become helpless because most of the patient’s information is noted in the computer and delays in treatment and management decisions are imminent.

Nine unintended adverse consequences of the use of EHR

1. Work for clinicians
2. Unfavorable workflow changes
3. Never ending demands for system changes
4. Conflicts between electronic and paper-based systems
5. Unfavorable changes in communication patterns and practices
6. Negative user emotions
7. Generation of new kinds of errors
8. Unexpected and unintended changes in institutional power structure
9. Overdependence on technology

Effects of EHRs with Antibiotic Stewardship in long term care facilities

Long term care residents represent a growing percentage of our society with complicated healthcare needs. Prescribing antibiotics in this population has been known to be a worldwide issue raising concern about how this may drive antibiotic resistance and enable spread by person to person transmission. In the long term care setting, a nurse notifies the clinician on behalf of the resident regarding the change of condition and other relative information such as diagnostic tests, vital signs and assessment. Since majority of these facilities do not have on site clinicians, relying on the nurses’ assessment on treatment decisions takes place (Patterson et al., 2019). If an of what the situation is given by the nurse, this may result to an unnecessary antibiotic prescription. In addition, these information like diagnostic laboratory results, medical imaging, vital signs or assessment data may not be inputted in the EHR on time due to time constraints. Therefore, the need to assess appropriate approaches to communicating signs and symptoms to clinicians may help promote a better antibiotic stewardship program.

Innovative strategies done by the Arizona Department of Health Services

I got in touch with Rachana Bhattarai, BVSc&AH, MS, PhD, CIC, a Healthcare-Associated Infections Epidemiologist, Office of Infectious Disease Services of the Arizona Department of Health Services and was able to talk to her regarding steps to promote antibiotic stewardship in long term care facilities. She states that the Arizona Department of Health Services have been partnering with an antimicrobial stewardship expert from the University of Arizona and using research to find ways in promoting better approaches to eradicate antibiotic resistance in long term care facilities. In addition, the organization have been educating healthcare facilities about antibiotic stewardship through flyers and constant communication. Moreover, the organization has been analyzing current antibiotic susceptibility patterns and prescribing practices in Arizona and promoting antibiotic awareness campaigns. In addition, AZ DHS implements that diagnosing health care provider or an administrator of a health care institution transferring a case with active infection of a bacterial disease, for which the agent is known to be a multidrug-resistant organism, to another health care provider or health care institution or to a correctional facility shall, either personally or through a representative, ensure that the receiving health care provider, health care institution, or correctional facility is informed that the patient is infected with a multidrug-resistant organism. This may be through a phone conference, email or other communication means.

At this day and age, technology has made our lives better and easier. Nevertheless, there are benefits and drawbacks in using it.  As the drivers of technology, humans are always working hard to make changes and advance this system. If we try to look back to the core goal, which is to deliver safe and quality care, we can use technology and innovation to avoid errors and promote better quality of life and patient satisfaction.

References

Mcbride, S., & Tietze, M. (2018). Nursing Informatics for the Advanced practice nurse, Second edition: Patient safety, quality, outcomes, and interprofessionalism. New York: Springer Publishing Company.

Patterson, L., Maguire, A., Cardwell, C., Kee, F., Hughes, C., Geoghegan, L. . . O’Reilly, D. (2019). Evidence of a care home effect on antibiotic prescribing for those that transition into a care home: A national data linkage study. Epidemiology and Infection, 147, Epidemiology and Infection, 2019, Vol.147.