Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes: experiences from a research partnership

Magda Raban; Rajendra Gyawali; Amy Nguyen; Lyn-li  Lim; Kyle Stewart; Johanna Westbrook

doi:10.3233/SHTI250293

Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes: experiences from a research partnership

Magda Raban, Rajendra Gyawali, Amy Nguyen, Lyn-li Lim , Kyle Stewart, Johanna Westbrook

Australian Institute of Health Innovation

Research output: Chapter in Book/Report/Conference proceeding › Conference proceeding contribution › peer-review

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Abstract

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.

Original language	English
Title of host publication	Intelligent health systems
Subtitle of host publication	from technology to data and knowledge. Proceedings of MIE 2025
Editors	Elisavet Andrikopoulou, Parisis Gallos, Theodoros Arvanitis, Rosalynn Austin, Arriel Benis, Ronald Cornet, Panagiotis Chatzistergos, Alexander Dejaco, Linda Dusseljee-Peute, Alaa Mohasseb, Pantelis Natsiavas, Haythem Nakkas, Phillip Scott
Place of Publication	Amsterdam
Publisher	IOS Press
Pages	158-162
Number of pages	5
ISBN (Electronic)	9781643685960
DOIs	https://doi.org/10.3233/SHTI250293
Publication status	Published - 15 May 2025

Publication series

Name	Studies in Health Technology and Informatics
Publisher	IOS Press
Volume	327
ISSN (Print)	0926-9630
ISSN (Electronic)	1879-8365

Bibliographical note

Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Antimicrobial stewardship
clinical decision support
nursing homes

Access to Document

10.3233/SHTI250293Licence: CC BY-NC

Publisher version (open access)Final published version, 354 KBLicence: CC BY-NC

Cite this

Raban, M., Gyawali, R., Nguyen, A., Lim , L., Stewart, K., & Westbrook, J. (2025). Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes: experiences from a research partnership. In E. Andrikopoulou, P. Gallos, T. Arvanitis, R. Austin, A. Benis, R. Cornet, P. Chatzistergos, A. Dejaco, L. Dusseljee-Peute, A. Mohasseb, P. Natsiavas, H. Nakkas, & P. Scott (Eds.), Intelligent health systems: from technology to data and knowledge. Proceedings of MIE 2025 (pp. 158-162). (Studies in Health Technology and Informatics; Vol. 327). IOS Press. https://doi.org/10.3233/SHTI250293

Raban, Magda ; Gyawali, Rajendra ; Nguyen, Amy et al. / Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes : experiences from a research partnership. Intelligent health systems: from technology to data and knowledge. Proceedings of MIE 2025. editor / Elisavet Andrikopoulou ; Parisis Gallos ; Theodoros Arvanitis ; Rosalynn Austin ; Arriel Benis ; Ronald Cornet ; Panagiotis Chatzistergos ; Alexander Dejaco ; Linda Dusseljee-Peute ; Alaa Mohasseb ; Pantelis Natsiavas ; Haythem Nakkas ; Phillip Scott. Amsterdam : IOS Press, 2025. pp. 158-162 (Studies in Health Technology and Informatics).

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abstract = "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.",

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Raban, M , Gyawali, R , Nguyen, A, Lim , L, Stewart, K & Westbrook, J 2025, Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes: experiences from a research partnership. in E Andrikopoulou, P Gallos, T Arvanitis, R Austin, A Benis, R Cornet, P Chatzistergos, A Dejaco, L Dusseljee-Peute, A Mohasseb, P Natsiavas, H Nakkas & P Scott (eds), Intelligent health systems: from technology to data and knowledge. Proceedings of MIE 2025. Studies in Health Technology and Informatics, vol. 327, IOS Press, Amsterdam, pp. 158-162. https://doi.org/10.3233/SHTI250293

Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes: experiences from a research partnership. / Raban, Magda ; Gyawali, Rajendra ; Nguyen, Amy et al.
Intelligent health systems: from technology to data and knowledge. Proceedings of MIE 2025. ed. / Elisavet Andrikopoulou; Parisis Gallos; Theodoros Arvanitis; Rosalynn Austin; Arriel Benis; Ronald Cornet; Panagiotis Chatzistergos; Alexander Dejaco; Linda Dusseljee-Peute; Alaa Mohasseb; Pantelis Natsiavas; Haythem Nakkas; Phillip Scott. Amsterdam: IOS Press, 2025. p. 158-162 (Studies in Health Technology and Informatics; Vol. 327).

Research output: Chapter in Book/Report/Conference proceeding › Conference proceeding contribution › peer-review

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T2 - experiences from a research partnership

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AU - Gyawali, Rajendra

AU - Nguyen, Amy

AU - Lim , Lyn-li

AU - Stewart, Kyle

AU - Westbrook, Johanna

N1 - Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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Raban M , Gyawali R , Nguyen A, Lim L, Stewart K, Westbrook J. Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes: experiences from a research partnership. In Andrikopoulou E, Gallos P, Arvanitis T, Austin R, Benis A, Cornet R, Chatzistergos P, Dejaco A, Dusseljee-Peute L, Mohasseb A, Natsiavas P, Nakkas H, Scott P, editors, Intelligent health systems: from technology to data and knowledge. Proceedings of MIE 2025. Amsterdam: IOS Press. 2025. p. 158-162. (Studies in Health Technology and Informatics). doi: 10.3233/SHTI250293

Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes: experiences from a research partnership

Abstract

Publication series

Bibliographical note

Keywords

Access to Document

Other files and links

Fingerprint

Transforming residential aged care through evidence-based informatics

Cite this

Designing a clinical decision support prototype for urinary tract infection treatment in nursing homes: experiences from a research partnership

Abstract

Publication series

Bibliographical note

Keywords

Access to Document

Other files and links

Fingerprint

Projects

Transforming residential aged care through evidence-based informatics

Cite this