Nienke de Jong*, University of Twente, Enschede, Netherlands Jobke Wentzel*, University of Twente, Enschede, Netherlands Lex van Velsen, University of Twente, Enschede, Netherlands Lisette van Gemert-Pijnen*, University of Twente, Enschede, Netherlands Track: Research Presentation Topic: Web 2.0 approaches for clinical practice, clinical research, quality monitoring Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2013-09-25

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Background: Due to imprudent and uncontrolled antibiotic use in the past, microorganisms have become resistant or are on the verge to become so. If we continue to use antibiotics irresponsibly, soon we will not be able to treat a lot of diseases like Tuberculosis. Antimicrobial stewardship programs (ASPs) are proposed as a necessary means to stop antimicrobial resistance. In these programs, strategies such as prescribing restrictions, formularies, clinical decision support, pharmacy and clinical microbiology consultations, and resistance monitoring are implemented in hospitals to improve the appropriateness of patients’ antimicrobial therapy. As ASPs rely on interdisciplinary cooperation and consultation, and information-sharing, eHealth interventions can facilitate these new clinical practices. Current ASP technologies focus solely on specialist support such as physician prescribing support, clinical decision aids and reminders. The goal of our study was to go beyond physicians and to apply a participatory design strategy to uncover what processes in ASP can be supported via eHealth and who the important stakeholder are.

Methods: We followed a participatory development approach starting with stakeholder dialogues via focus groups to assess what the relevant problems and key-stakeholders are for supporting ASPs. Participants were recruited via a top clinic and local teaching hospital. An unexpected focus on nurses’ needs in ASPs emerged as a key stakeholder in patient centered care via ASP. We held in-depth focus groups, observations and interviews with nurses, management and ASP experts (clinical microbiologists and pharmacists) of the hospital to further explore their needs and we translated the results into and requirements for an eHealth intervention. Next, card-sorts, mock-up and scenario evaluations were performed with nurses of two pulmonology wards to further develop a mobile ASP nurse information app.

Results: Due to our participatory design, we uncovered that supporting nurses in their work was an important concern to enable antimicrobial stewardship. Their involvement turned out to be implicit, but nonetheless crucial. However, as their workload is already high, nurses were hesitant to take up additional activities in an ASP. Our mapping of nurses’ working methods and information behavior regarding antimicrobial-related tasks, revealed that basic information needs were unmet. In several iterations, we developed a web-based mobile ASP support application that is attuned to nurses’ workflow and antimicrobial-related tasks, such as preparing and administrating antimicrobials, evaluating patients, and check for and act upon alarming changes in patient status. Currently, this mobile application is being tested for task supporting effectiveness on three wards. We will show the latest version of the app during our presentation, including preliminary evaluation results.

Conclusions: Our study shows that participatory design of eHealth interventions can guide eHealth development projects towards the best solution, and can stimulate out-of-the-box thinking. The development of our nurse information app has shown that clinical practice implications are important and offer a good starting point countering the implications of antimicrobial resistance, a worldwide health problem. Interestingly, physicians have shown interest in a similar support app, fitted to their ASP needs, after having seen prototypical versions of the app for nurses. This shows that thinking outside the box does not only lead to new eHealth solutions, it can also enhance the existing ones.