P1934 How to develop and implement a computerised decision support system integrated into the electronic prescribing for antimicrobial stewardship? Experience from two Swiss hospital systems Gaud Catho*1, Roberta Valotti 2, Brigitte Waldispühl Suter3, Javier Portela4, Serge Sa Silva4, Francesco Pagnamenta3, Nicolo Saverio Centemero3, Valentina Coray3, Nathalie Vernaz5, Rodolphe Meyer4, Benedikt Huttner1,6

1 Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland, 2 Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale,, Lugano, Switzerland, 3 Division of Clinical Informatics, Ente Ospedaliero Cantonale, Bellinzona, Switzerland, 4 Division of Informatics, Geneva University Hospitals, Geneva, Switzerland, 5 Medical Directorate, Geneva University Hospitals, University of Geneva, Geneva, Switzerland, 6 Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland Background: Antimicrobial stewardship (AMS) programs has been shown to improve antibiotic use, reduce antimicrobial resistance and improve patient care (1). Many AMS interventions require intensive human resources and are difficult to sustain in the long-term. Computerized decision support systems (CDSS) provide new opportunities for automating some AMS interventions and integrating them in routine healthcare. CDSS are recommended as part of AMS programs by international guidelines (2), yet developing and implementing such systems faces several challenges that we wish to describe here. Materials/methods: We developed and implemented two CDSS integrated into the in-house electronic health records in three public hospitals in Switzerland (Geneva, Lugano and Bellinzona) in the context of the COMPASS study (clinicaltrials.gov: NCT03120975). The decision support encourages physicians to follow local guidelines for empiric antibiotic therapy and duration of treatment and to regularly reevaluate treatment. Results: The development of the system and its integration into the computerized physician order entry system took between 9 (Ticino) and 12 months (Geneva). Despite a relatively simple algorithm without incorporation of much patient-specific data, the integration in electronic prescribing was complex. Each step and pathway should be clearly described and early involvement of all the stakeholders is crucial. The use of standardized terminologies such as ICD10 to avoid free-text is essential for analysis purposes and long-term sustainability. Ergonomic and user-friendliness are two other key points (Figure 1). The trade-off between entering in the system structured data and providing a safe and user-friendly prescribing process through the user interfaces was challenging. The COMPASS study developments will be part of a more global clinical information system platform designed to support new CDSS COMPASS-like initiatives and COMPASS future evolutions. Development agility, security and scalability constitute the DNA of these kind of projects. Conclusions: When designing and developing a CDSS, close collaboration between the IT team and clinicians is essential. IT team with development expertise is required. In-house software for electronic prescribing offers the flexibility to implement such interventions. This CDSS will be evaluated by a cluster-randomized trial during a 12 months intervention period (3) in which process and qualitative outcomes will be assessed. 29TH ECCMID 13-16 APRIL 2019 AMSTERDAM, NETHERLANDS POWERED BY M-ANAGE.COM