Implementation description of a SIMRS-Based Warning System and Automatic Stop Order for Antibiotic Therapy in a Teaching Hospital
DOI:
https://doi.org/10.59247/jahir.v4i2.427Keywords:
Antibiotic stewardship, Automatic stop order, Clinical decision support, SIMRS, Teaching hospitalAbstract
Prolonged antibiotic therapy without timely reassessment remains an important challenge in hospital antimicrobial stewardship. A teaching hospital implemented a Hospital Management Information System (SIMRS)-based warning system and automatic stop order to support prospective review of inpatient antibiotic prescriptions. The system generated electronic warnings on days 3, 4, and 5 of therapy, and on day 5 required the doctor in charge of the patient (DPJP) to document the clinical reason for continuing antibiotics beyond five days. If the justification was not completed, the antibiotic order was automatically stopped and could not be processed by the pharmacy service. This study describes the implementation of a warning system and automatic stop order for antibiotics from October 2025 to May 2026. Descriptive analysis was performed using prescription counts, patient-days, antibiotic-days, days of therapy (DOT) per 100 patient-days, and distribution of prescriptions by therapy-day category. During the observation period, 1,761 antibiotic prescriptions were followed through SIMRS, with 11,677 patient-days and 6,233 antibiotic-days. Antibiotic exposure was 53.38 DOT per 100 patient-days, prescription density was 15.08 prescriptions per 100 patient-days, and the mean exposure was 3.54 antibiotic-days per prescription. Most prescriptions were recorded during days 1-3 (1,033; 58.66%), followed by day 4 (248; 14.08%), day 5 (174; 9.88%), and more than five days (306; 17.38%). 3161 total antibiotic confirmations, 2871(90,83%) continued antibiotics and 290 (9,17%) did not continue antibiotics. The system created a structured digital pathway for reassessment and identified extended prescriptions that could be prioritised for stewardship audit. This early implementation evaluation suggests that integrating alerts, mandatory justification, and pharmacy workflow may strengthen antibiotic governance in teaching hospitals
References
World Health Organisation, "Antimicrobial resistance," WHO Fact Sheet, 2023.
H. A. Stewardship, R. R. Redfeld, and R. Khabbaz, “The Core Elements of Core Elements Of Hospital Antibiotic Stewardship Programs.” [Online]. Available: https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.
Kementerian Kesehatan Republik Indonesia, "Peraturan Menteri Kesehatan Nomor 8 Tahun 2015 tentang Program Pengendalian Resistensi Antimikroba di Rumah Sakit," 2015.
Kementerian Kesehatan Republik Indonesia, "Peraturan Menteri Kesehatan Nomor 28 Tahun 2021 tentang Pedoman Penggunaan Antibiotik," 2021.
A. L. Wirtz et al., “Effectiveness and safety of mandatory antimicrobial indications and durations and a pharmacist-driven 48-hour time-out in a pediatric hospital,” American Journal of Health-System Pharmacy, vol. 77, no. 8, pp. 614–621, Apr. 2020, doi: 10.1093/ajhp/zxaa029.
D. Bosetti, R. Grant, and G. Catho, “Computerized decision support for antimicrobial prescribing: what every antibiotic steward should know,” Antimicrobial Stewardship and Healthcare Epidemiology, vol. 5, no. 1, Sep. 2025, doi: 10.1017/ash.2025.10091.
S. Parzen-Johnson et al., “Use of the Electronic Health Record to Optimize Antimicrobial Prescribing,” Oct. 01, 2021, Elsevier Inc. doi: 10.1016/j.clinthera.2021.09.009.
PHO, “Antimicrobial Stewardship Strategy: Automatic stop orders.” [Online]. Available: http://www.cjhp-online.ca/index.php/cjhp/article/viewFile/13/12
R. K. Ross et al., “Safety of Automatic End Dates for Antimicrobial Orders to Facilitate Stewardship,” Infect. Control Hosp. Epidemiol., vol. 37, no. 8, pp. 974–978, Aug. 2016, doi: 10.1017/ice.2016.103.
F. Leo et al., “Impact of a computerized physician order entry (CPOE)-based antibiotic stewardship intervention on the treatment duration for pneumonia and COPD exacerbations,” Respir. Med., vol. 186, Sep. 2021, doi: 10.1016/j.rmed.2021.106546.
J. A. Jenkins, S. K. Pontefract, K. Cresswell, R. Williams, A. Sheikh, and J. J. Coleman, “Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures,” Jun. 01, 2022, Oxford University Press. doi: 10.1093/jacamr/dlac063.
M. S. Benić et al., “Metrics for quantifying antibiotic use in the hospital setting: Results from a systematic review and international multidisciplinary consensus procedure,” Journal of Antimicrobial Chemotherapy, vol. 73, pp. vi50–vi58, Jun. 2018, doi: 10.1093/jac/dky118.
A. M. Morris, “Antimicrobial Stewardship Programs: Appropriate Measures and Metrics to Study their Impact,” Curr. Treat. Options Infect. Dis., vol. 6, no. 2, pp. 101–112, Jun. 2014, doi: 10.1007/s40506-014-0015-3.
A. Miranda-Barros, G. Pilco-Bonilla, and D. Guaman-Lozada, “Electronic clinical decision support tools in antibiotic prescribing: A systematic review,” Pharm. Pract. (Granada)., vol. 23, no. 2, Apr. 2025, doi: 10.18549/PharmPract.2025.2.3182.
A. Kouri, J. Yamada, J. Lam Shin Cheung, S. Van de Velde, and S. Gupta, “Do providers use computerized clinical decision support systems? A systematic review and meta-regression of clinical decision support uptake,” Dec. 01, 2022, BioMed Central Ltd. doi: 10.1186/s13012-022-01199-3.
L. Westerbeek et al., “Barriers and facilitators influencing medication-related CDSS acceptance according to clinicians: A systematic review,” Aug. 01, 2021, Elsevier Ireland Ltd. doi: 10.1016/j.ijmedinf.2021.104506.
T. M. Khadem et al., “Impact of Clinical Decision Support System Implementation at a Community Hospital With an Existing Tele-Antimicrobial Stewardship Program,” Open Forum Infect. Dis., vol. 9, no. 7, Jul. 2022, doi: 10.1093/ofid/ofac235.
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