Authors (including presenting author) :
Chu JPM (1), Fong BKY (1), Chan JKY (1), Tong AYH (1), Kwok CT (1), Ho ESL (1), Woo RBK (1), Pang YWJ (1), Cheung NT (1)
Affiliation :
(1) Information Technology and Health Informatics Division, Hospital Authority Head Office, HKSAR
Introduction :
The World Health Organization (WHO) declared that antimicrobial resistance (AMR) is a one of the top ten global public health threats for humanity, which caused 1.27 million deaths globally in 2019 and it estimated AMR will cause 10 million deaths by 2050. The Hong Kong government recognized the threat by AMR and setup the High Level Steering Committee on Antimicrobial Resistance (HLSC) to formulate the strategy to tackle AMR. One of the key actions is to optimize the use of antimicrobials with strategic intervention via enhancement of Antibiotic Stewardship Programme (ASP) in public hospital. To ensure the appropriate use of antimicrobials in Hospital Authority (HA), ASP is the multidisciplinary, prospective and interventional approach to reduce unnecessary antibiotic prescriptions, prevent the emergence of AMR, and control medical expenses. In order to support ASP in HA, a clinical data driven IT solution, Smart ASP, has been developed in 2024 to provide decision support reminders and case audit.
Objectives :
Integration of clinical protocol with electronic medical records to ensure appropriate use of antibiotics in HA by delivering recommendations to clinicians via an innovative Smart ASP decision support system. 1. Providing medication decision support for high impact antibiotics. 2. Analyzing antibiotic prescription pattern to facilitate stakeholders understanding AMR situation in HA, in order to optimize antibiotic use, prevent AMR emergence and improve patient outcome.
Methodology :
Smart ASP is an innovative IT solution which leverages clinical data analytics to identify potentially inappropriate antimicrobial prescriptions and provide decision support to clinicians. 1. The ASP protocol for checking patient admission discharge information, laboratory results, medication history and vital sign data are integrated in a data analytic platform, Artificial Intelligence Data Analytics (AIDA), to identify potentially inappropriate antimicrobial prescriptions. 2. The automated recommendation for prescription is provided to clinicians in In-patient Medication Order Entry (IPMOE). 3. The data driven Smart ASP patient list with potentially inappropriate prescription and the e-documentation form support ASP team review process and monitor prescription behavior. 4. The comprehensive performance monitoring report is generated to stakeholders for auditing.
Result & Outcome :
Smart ASP targets to optimize ASP review process and acts as a decision supporting tool to clinicians in HA. The system piloted with meropenem prescription in Prince of Wales Hospital and Princess Margaret Hospital in January 2024. Having the positive feedback from ASP team, the system successfully extended to cover six more antibiotics (piperacillin-tazobactam, imipenem, ertapenem, cefepime, cefoperazone-sulperazon, and vancomycin) in 17 acute hospitals in May 2024. And monitoring for antibiotics IV to oral switch (amoxicillin-clavulanic acid, ciprofloxacin, levofloxacin as surrogate markers) have been implemented in October 2024. Smart ASP decision support system has been extended to 15 convalescent hospitals in February 2025. Future Directions • Expansion to additional antimicrobials in 2025/26. • System enhancement to provide real-time decision support. • Improve Smart ASP with Artificial Intelligence Smart ASP has demonstrated significant potential in improving antimicrobial prescription practices, reducing AMR risks and enhancing patient care in Hong Kong’s public hospitals. Acknowledge This paper would not have been possible without the invaluable expertise and continuous support of the Working Group on Antibiotic Stewardship Programme (WGASP). We are deeply grateful for their contributions.
