2025 Southeastern Residency Conference

Title: Standardization of Inpatient Dashboard Procedure To Impact Quantitative Documentation of Pharmacist Interventions on Bacteremia
Author: Brooke Jordan-Brown, Sara Lucas, Landon Johnson

Background:
The Ralph H. Johnson VA Healthcare System (RHJ VAHS) utilizes a decentralized pharmacy practice model. Time constraints limit documentation of pharmacist interventions, which ultimately results in undocumented interventions. An inpatient dashboard was recently created to identify interventions and increase documentation.  However, there is no standardized process to incorporate this new tool into pharmacist workflow. Despite recognized benefits of clinical pharmacists, the lack of standardized documentation process limits the visible impact and value that clinical pharmacists contribute to patients. This quality improvement project aims to standardize documentation of pharmacist interventions for bacteremia within the RHJ VAHS.

Methods:
A standardized procedure was developed for utilizing the inpatient dashboard, focusing on antimicrobial stewardship flags. Focus was placed on bacteremia given the significant impact clinical pharmacists can have on optimizing antimicrobials. Interventions were documented through an antibiotic timeout note. Pharmacists were educated on this standardization process in October 2024. The new procedure took effect November 2024. Education emphasized the importance of documenting all antibiotic related interventions. Data was collected on all patients admitted for bacteremia from July 1st, 2024 to February 28th, 2025, with a pre-intervention period from July to October and post intervention period from November to February. The primary endpoint was the change in the quantity of pharmacist interventions for bacteremia following education and implementation of the standardized dashboard procedure. The secondary endpoint assessed the frequency of dashboard use by pharmacists after implementation. Data on hospitalizations for bacteremia (identified by positive blood cultures), bacteremia interventions (identified by bacteremia data points in the EHR) , and dashboard interaction metrics were collected for analysis.

Results:
In the pre-intervention period there was a total of 41 hospitalizations for bacteremia with 18 bacteremia interventions (43.9%).  In the post-intervention period there was a total of 52 hospitalizations for bacteremia with 32 bacteremia interventions (61.5%). The change in quantity of pharmacist interventions was not statistically significant (p=0.0903). In the post-intervention period, 90.6% of the bacteremia interventions were through the antibiotic timeout note, while the remaining 9.6% were from the previous methods of documentation. For the secondary endpoint, in the pre-intervention time period, the dashboard view history was 7,575 and in the post-intervention period, the dashboard view history was 5,904, (p=  <0.00001). For flag touches with removing/snoozing/resolving, in the pre-intervention period, the total flag touches was 3,540 (31%/17%/52% respectively) and in the post-intervention period, the total flag touches was 2,762 (34%/16%/50% respectively) (p=0.1167).

Conclusion:
Overall, there was no statistically significant increase in quantitative documentation of bacteremia interventions after implementing the standardized dashboard procedure. However, there is a strong signal towards an increase in the number of bacteremia interventions in the post-intervention period, demonstrating that the sample size was likely too small to show statistical significance. In contrast there was a statistically significant decrease in view history of the dashboard, indicating a disconnect in the number of bacteremia interventions and dashboard use. Based off these results, the antibiotic timeout note is likely an efficient method to document bacteremia interventions. The inpatient dashboard is a tool that can assist pharmacists in making interventions, however methods of documentation may impact the number of interventions more so than utilization of the dashboard.