Letter to the Editor

We read the editorial by Robert Pearce and Ian Whyte with interest.1 We agree that electronic medication management is a step forward in access to prescribing and administration records with capability for passive and active decision support.

Electronic medication systems have positively impacted the antimicrobial stewardship post-prescribing rounds conducted at our health service. At the click of a button, we get a snapshot of all current hospital inpatients prescribed an antimicrobial. This significantly improves efficiency. Also, electronic approval rates for restricted antimicrobials have increased significantly related to the embedded clinical-decision support that alerts prescribers when a restricted antimicrobial is being prescribed. We recognise, however, that this has not removed the need for a separate electronic approval system for antimicrobials, or antimicrobial stewardship post-prescribing rounds.

We acknowledge that the challenges of implementing electronic medication management include developing a clear process of local stakeholders having input and being able to provide timely feedback on local improvements to generic software. For antimicrobials, we have recommended changes on common dosing and turning on of some alerts that were initially turned off to minimise alert fatigue.

Electronic medication management also offers new opportunities to practise antimicrobial stewardship. It is easy and fast to identify patients on any antimicrobial, not just the restricted ones that have made it into the electronic antimicrobial approval system. This allows the scope of antimicrobial stewardship teams to potentially expand to review prescribing practice for non-restricted antimicrobials rather than traditionally relying on usage data.

Lyn-li Lim
Antimicrobial stewardship physician

Kylie D’Arcy-Evans
Antimicrobial stewardship pharmacist

Sonia Koning
Lead antimicrobial stewardship pharmacist

Eastern Health, Melbourne


Author's response

Ian Whyte, one of the author’s of the article, comments:

This correspondence highlights the significant advantages of having rapid access to individual prescribing information. This is not only true in antimicrobial stewardship, but also for reviewing the use of high-risk drugs such as anticoagulants, for auditing venous thromboembolism prophylaxis and for medication reconciliation.

Electronic medication management should provide opportunities for other groups of clinicians to streamline their processes, as the antimicrobial stewardship group in Eastern Health has shown.

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Lyn-li Lim

Antimicrobial stewardship physician, Eastern Health, Melbourne

Kylie D’Arcy-Evans

Antimicrobial stewardship pharmacist, Eastern Health, Melbourne

Sonia Koning

Lead antimicrobial stewardship pharmacist, Eastern Health, Melbourne

Ian Whyte

Director, Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Hunter New England Local Health District, New South Wales