Title: Improvement of pharmacist’s antimicrobial stewardship interventions through electronic health record technology
Authors: Tyler E. Merrill, PharmD; Craig P. Worby, PharmD, BCIDP, BCCCP, BCPS; Julie Ann Justo, PharmD, MS, FIDSA, BCPS; Russell D. Poisson, PharmD
Learning Objective: Enhance pharmacists’ ability to optimize antimicrobial stewardship (AMS) interventions through the use of enhancements to the AMS module of the electronic health record (EHR).
Background/Objective: The primary objective of this study was to improve the quality and quantity of pharmacist’s antimicrobial stewardship interventions. The secondary objective of this study was to improve the actionability of AMS prompted scoring rules.
Methods: From October 1st, 2025, through May 1st, 2026, data was collected from the EHR to identify pharmacist AMS interventions. This multi-phase project began with updating the antimicrobial scoring rules in the EPIC Bugsy model. Investigators reassessed and ranked these rules by clinical importance. Based on this ranking, the AMS display was redesigned with informatics support to improve usability. In Phase I, an online survey was conducted for pharmacists to provide their thoughts and feedback on the previous AMS system. In this survey, pharmacists selected Bugsy alerts they perceived as most and least useful, voted on Bugsy’s compatibility with workflow, and ranked ease of use and navigation. In Phase II, a follow-up survey assessed pharmacist perspectives on the redesigned system and compared results to baseline responses. The updated scoring display and alert system aimed to improve the quality of Bugsy alerts and its incorporation within pharmacist’s daily responsibilities.
Results:
Pre-update survey results (n=14) found bug–drug mismatch (24%) and IV-to-PO conversion (19%) as the most useful Bugsy alerts, while duplicate coverage (27%) was selected as the least useful. Daily use was 57%. The two most common workflow fits were “somewhat well” (57%) and “very well” (21%); mean usability score was 2.43 out of 5. Post-update survey results (n=13) at 2 months showed bug–drug mismatch (38%) and restricted antimicrobial alerts (15%) as most useful; days of therapy (30%) was ranked least useful. Daily use rose to 62%. Workflow ratings were more dispersed with “somewhat well” (31%), “very well” (23%), “somewhat poorly” and “very poorly” (38% combined). Mean usability score improved to 2.15 out of 5.
Conclusion: After the Bugsy revamp, perceived usefulness of bug-drug mismatch alerts, daily use, and overall usability improved. Workflow compatibility ratings were mixed from pre- and post-update survey results. Some alerts, including days of therapy, warrant refinement to improve actionability. Future work should prioritize pharmacist-driven improvements, alert customization, and include clinical stewardship outcomes to better assess Bugsy’s impact.
Self-Assessment Question:
Which of the following best reflects the goals of enhancing pharmacist’s AMS interventions?
- Decrease pharmacist interventions to improve workflow efficiency.
- Improve both the effectiveness and frequency of AMS interventions while optimizing scoring rule usability.
- Eliminating AMS scoring systems in favor of physician-led decision-making.
- Prioritizing antimicrobial cost reduction rather than clinical outcome consideration.
