Designing a Clinical Decision Support Prototype for Urinary Tract Infection Treatment in Nursing Homes: Experiences from a Research Partnership

The inappropriate use of antibiotics is frequent in nursing homes (NHs) putting older adults at risk of adverse events and contributing to the rise of antimicrobial resistance. Urinary tract infections (UTIs) account for 30-50% of antibiotic prescribing in NHs, but have one of the highest rates of inappropriate antibiotic use. Clinical decision support (CDS) embedded in electronic prescribing can assist in ensuring antibiotic appropriateness. In this study, we aimed to develop a CDS prototype to improve prescribing for UTIs in NHs in collaboration with an IT system provider, BESTMED. We used electronic health record data to identify CDS goals, and held design workshops with IT developers and an infectious diseases physician. Antibiotic choice and duration of treatment were identified as key areas requiring improvement, and thus the CDS goals. The final CDS prototype featured alerts when duration and antibiotic choice were not guideline concordant. A key challenge was ensuring the CDS operated within existing prescribing workflows. Plans for user testing and piloting the CDS to measure usability, acceptability and effectiveness are described.