Approximately 30% of antimicrobial use in hospitals and community settings has been shown to be unnecessary or inappropriate, contributing to the development of antimicrobial resistance, prolonged hospital stays, as well as increased rates of Clostridioides difficile (also known as Clostridium difficile) infection, health care costs and patient mortality. Antimicrobial stewardship programs (ASP) are tasked to ensure clinicians select the appropriate antimicrobial for their patient, when indicated, at the right dose and duration, to optimize patient outcomes while reducing the risk of resistance. Prescribing antimicrobials, however, is a complex process and many factors must be considered including current evidence-based guidelines as well as local factors such as hospital or community specific resistance data.
Last year, the Saskatoon Antimicrobial Stewardship Program (ASP) took innovative steps and implemented a novel mobile app platform to transform antimicrobial prescribing patterns. Technology in health care is proliferating and given the ubiquitous use of smartphones amongst health care professionals, a novel platform for knowledge translation in antimicrobial stewardship has emerged. Prior research has shown that mobile applications have potential to increase awareness of antimicrobial stewardship, change and standardize antimicrobial prescribing behaviors in concordance with local clinical guidelines and reduce inappropriate usage of broad-spectrum antimicrobials.
The Saskatoon ASP collaborated with Spectrum, a mobile app that can be customized to deliver local antimicrobial stewardship resources in any hospital and employed directly at the point of care. By accessing the free mobile app, healthcare professionals have access to a wealth of information including local, evidence-based guidelines, pathogen and antimicrobial information that incorporates local resistance patterns and updated antimicrobial formulary content. Each guideline is presented in an algorithmic format for ease of use and can incorporate individualized patient factors and local resistance patterns to provide tailored, evidence-based recommendations. Features such as duration of therapy, prompts to narrow therapy and oral stepdown can also be built into each clinical pathway. Unlike pocket cards and guidebooks, Spectrum makes it easy to update and distribute local antimicrobial recommendations to clinicians.
Spectrum has been successfully implemented in more than 15 centres across North America, evidence of its emergence as a key leader at the forefront of antimicrobial stewardship mobile app technology. Spectrum has recognized issues and barriers contributing to sub-optimal prescribing practices and has transformed the prescribing process by centralizing all local antimicrobial stewardship resources and making them easily accessible at the point of care. In addition to significantly improving prescriber efficiency, Spectrum has reduced the administrative burden on antimicrobial stewardship leaders by simplifying the process of updating and distributing local resistance data and clinical pathways.
Through collaboration with Spectrum, the Saskatoon ASP has transformed the culture of antimicrobial prescribing, encouraging clinicians to use technology to improve the appropriateness of their prescribing practices and increasing adherence with evidence-based guidelines. The clinical pathways, local resistance data, pathogen and antimicrobial information delivered by Spectrum were developed and curated via collaboration between specialists in Infectious Diseases, Medical Microbiology and Pharmacy. Collaboration and engagement with clinicians who frequently prescribe antimicrobials using workflow analyses, education and evaluation initiatives, has been critical in driving change along with the vocal support of senior leadership.
Spectrum was officially launched in Saskatoon on April 12, 2018 and made available for all healthcare professionals to download, access and use for free for clinicians. Within one week, over 500 healthcare professionals had downloaded Spectrum, exemplifying its rapid adoption. Sustained use with over eight hundred active users has been demonstrated. In November 2018, Spectrum content was accessed over 2,400 times.
Spectrum users include physicians, pharmacists, residents, nurses, medical students and more. The most commonly accessed clinical pathways reflect common community-acquired infections and the average user spends two minutes and forty-two seconds accessing content, indicating clinicians can rapidly access relevant information. High usage was observed in Saskatoon but also extends to Regina, North Battleford, Prince Albert, Moose Jaw and Swift Current, reflecting significant reach throughout the province.
Following implementation of Spectrum on the medical units of Royal University Hospital in Saskatoon, a significant reduction in total antimicrobial use (25%) and anti-pseudomonal antimicrobial use (35%) was demonstrated over a nine-month period, likely reflecting improved guideline adherence and appropriateness of antimicrobial prescribing.
Developing innovative knowledge translation strategies to optimize antimicrobial usage with widespread impact are of critical need in Saskatchewan given limited antimicrobial stewardship resources. Furthermore, the Ministry of Health of Saskatchewan has recently prioritized antimicrobial stewardship and appropriateness of patient care. Through collaboration with Spectrum, the Saskatoon ASP has now provided clinicians with a refined and novel platform that is simple yet presents data in a rapid and unambiguous manner. Mobile app technology can be effective as an innovative knowledge translation tool in streamlining clinical decision support, improving guideline adherence and appropriateness of care and transforming healthcare delivery. Spectrum is an example of an innovative and effective strategy that can be used to help optimize patient outcomes and minimize antimicrobial resistance.
Spectrum was recently recognized as a top finalist for the Canadian Health Informatics Awards. Since the launch of Spectrum, users have agreed this innovation is useful, saves time, and makes workflow more efficient. To access the app and for more information, visit www.spectrum.md/saskatoon