Guidance DS: A web-based clinical decision support system for antimicrobial stewardship in hospitals

We describe a web-based drug approval and clinical decision support system called Guidance DS. The system was developed by a multidisciplinary team of clinicians, pharmacists, software developers and epidemiologist at the Royal Melbourne Hospital (RMH). Its design was informed by contextual enquiry and formative evaluation processes. Guidance DS has role based workflows for clinicians, senior prescribers, pharmacists, administrators and auditors. Its primary use has been antimicrobial stewardship, and the system has demonstrated significant improvements in antibiotic use and antimicrobial resistance since its deployment at the RMH in 2005 and at the Peter MacCallum Cancer Centre in 2007. The technology is suited to any clinical algorithm, guideline or other class of drug that requires surveillance or monitoring.In 2008, the government funded mandatory introduction of electronic antimicrobial stewardship systems to all major public hospitals in Victoria. As a result, we are now implementing Guidance DS to twelve other sites. These hospitals have widely variable infectious diseases support, information technology infrastructure and prescribing cultures. We will describe a tool that can be used to assess the readiness of a large institution to receive this type of technology, and therefore guide resource allocation to facilitate implementation. Based on our own experiences of instituting organisational change, we have also developed a detailed implementation checklist that we provide to all sites in conjunction with a consultative process.