Improved paediatric antimicrobial prescribing with a smartphone application: a before and after interventional study

Abstract

<jats:sec><jats:title>Introduction</jats:title><jats:p>Children have a high consumption of antimicrobials that require complicated decision-making by prescribers. Despite this, antimicrobial stewardship (AMS) interventions are often not translated into paediatric medicine. Script is a smartphone application (app) launched in Auckland, New Zealand to support decision-making for antimicrobial prescribers. The aim was to improve adherence to existing local clinical guidelines for both adult and paediatric infections.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Inpatient and emergency department antimicrobial prescriptions were prospectively collected and evaluated for guideline adherence. Baseline prescribing data were collected and compared with prescribing at 4 months and 1 year after the app was launched. Prescriptions were graded as ‘appropriate’ or ‘inappropriate’ by investigators. Grading was done blinded to timing of the prescription relative to the intervention.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Following the launch of the Script app, guideline adherence significantly increased from 241 of 348 (69%) antimicrobial prescriptions graded as appropriate during the baseline period to 301 of 359 (83%) after 4 months (p&lt;0.0001). This improvement from baseline was sustained at 1 year with 263 of 323 (81%) adherence (p&lt;0.001). At 1 year, this improvement could be demonstrated separately for medical, surgical and emergency department prescriptions.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>There was a significant and sustained improvement in adherence to paediatric antimicrobial guidelines following the introduction of a prescribing support app. The need to seek guidance for antimicrobial doses due to the age-based and weight-based calculations in paediatrics may mean that AMS interventions such as decision support and prescribing tools are particularly well suited to paediatric prescribing.</jats:p></jats:sec>