The use of best practice alerts with the development of an antimicrobial stewardship navigator to promote antibiotic de-escalation in the electronic medical record

Infect Control Hosp Epidemiol. 2013 Dec;34(12):1259-65. doi: 10.1086/673977. Epub 2013 Oct 28.


Objective: Develop a clinical decision support tool comprised of an electronic medical record alert and antimicrobial stewardship navigator to facilitate antimicrobial stewardship.

Design: We analyzed alerts targeting antimicrobial de-escalation to assess the effectiveness of the navigator as a stewardship tool. The alert provides antimicrobial recommendations, then directs providers to the navigator, which includes order management, relevant patient information, evidence-based clinical information, and bidirectional communication capability.

Setting: Academic, tertiary care medical center with an electronic medical record.

Intervention: Alerts containing stewardship recommendations and immediate access to the navigator were created.

Results: Antibiotic use and response data were collected 1 day before stewardship recommendation via the best practice alert (BPA) tool and 1 day after the BPA tool response. A total of 1,285 stewardship BPAs were created. Two hundred and forty-four (18.9%) of the BPAs were created and acted upon within 72 hours for the purpose of de-escalation: 169 (69%) were accepted, 30 (12%) were accepted with modification, and 45 (18%) were rejected. Statistically significant decreases in total antibiotic use as well as in use of broad-spectrum (anti-methicillin-resistant Staphylococcus aureus and anti-pseudomonal) agents occurred when accepted recommendations were compared with rejected recommendations.

Conclusions: We describe the successful development of a clinical decision support tool to perform prospective audit and feedback comprised of an alert and navigator system featuring evidence-based recommendations and clinical and educational information. We demonstrate that this tool improves antibiotic use through our example of de-escalation.

Trial registration: NCT01573195.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Decision Support Systems, Clinical*
  • Drug Therapy, Computer-Assisted
  • Electronic Health Records*
  • Humans
  • Medical Order Entry Systems*
  • Pilot Projects
  • Practice Guidelines as Topic
  • Software*


  • Anti-Bacterial Agents

Associated data