Partners for 20 years: Cape Cod Hospital and MEDITECH. Interview by Bill W. Childs.

Cape Cod Hospital (CCH), a 228-bed general acute care non-profit community hospital in Hyannis, MA, has been a customer of Medical Information Technology (MEDITECH) for 20 years. This lasting relationship between a vendor and a hospital is rather unique as you will discover in this interview with John E. Kilroy, director of Information Systems at Cape Cod Hospital.

Computer-assisted concurrent antibiotic review in a community hospital.

A computer-assisted program that monitors the appropriateness of antibiotic prescribing by matching microbiology reports and patient drug profiles is described. An antibiotic review committee in conjunction with the quality assurance department developed the computer-assisted antibiotic review program. An antibiotic order sheet was incorporated into the physicians' order form. Automatic stop dates were assigned according to the reason the antibiotic was ordered, e.g., surgical prophylaxis or documented infection. Numerous reports are generated from the data gathered from the physicians' order form. A drug/microbiology report is used to match patients' antibiotic drug profiles with their microbiology culture and sensitivity results. This report identifies all patients who have been receiving antibiotics for 72 hours or longer with sensitivities on file and mismatched sensitivity results. All mismatches that are considered important are investigated. Any actions taken are reported to the antibiotic review committee for peer review. The computer-assisted program has helped this hospital screen large populations of inpatients receiving antibiotics. The concurrent review of the drug/microbiology report has made it possible to detect within 24 hours, patients who are receiving antibiotics inappropriately. A computer can be used to perform daily concurrent antibiotic use review as a by-product of order entry by both the pharmacy and laboratory.

Bugs, drugs, and computers.

The paper describes the development, implementation, and review of a daily reporting system using data from two modules of a hospital information system: drug sensitivity reports from Microbiology, and patient drug profiles from Pharmacy. The system reviews each patient receiving antibiotics and compares that information with the patient's microbiology findings, looking for and flagging "no cultures," "negative cultures," and "mismatches," i.e., the patient is receiving an antibiotic to which the organism is resistant. Reports are produced daily and reviewed by the hospital's Infection Control nurse, who, in turn, notifies the attending physician when appropriate.