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A n a i s d o I HM T
pacting on antimicrobial resistant HAI and antibiotic use,
by leveraging the HP’s work.
Methods
HAITooL, a surveillance and decision-support open-
sourced information system (IS), was developed and
implemented, on the Design Science Research Meth-
odology framework (DSRM) [10].
The study has been conducted in three Portuguese Hos-
pitals. Full participation of the HP was ensured, count-
ing in each case, on the close collaboration of research-
ers and a multidisciplinary team of HP. The focus was
on better adjusting the process to Portuguese and local
organizational and socio-cultural context, leading HP
to adequate behavioral change.
Six sequential DSRM main steps [8] was planned and
accomplished, through a teamwork-based intervention
(Figure 1). Several interviews and surveys were per-
formed [11], in addition to the process observation and
intervention, under the principles of Österle for ab-
straction, originality, justification and benefit [12].
Results and discussion
HAITooL is a contextualized and validated information
system for surveillance and decision-support [9], un-
derpinning the operationalization of an effective ASP.
It was designed to leverage the professionals’ role,
strengthening their capacity and quality of work. It re-
sults from the collaborative work
between researchers and the multi-
ple key-actors in theASP (Figure 2).
The researchers, together with the
HP (including clinicians, the Infec-
tion and Prevention Control Team,
physicians, nurses, pharmacists, mi-
crobiologists and ICT technicians),
set up what the problem and priori-
ties were, as well as main objectives
for the solution. Important and nec-
essary data were pre-selected, for
the system co-design, implemen-
tation and demonstration. Evalua-
tion and communication, in form of
constant profiling, meeting and re-
porting, was central to understand
the problem, engage the team, fol-
low-up and disseminate the solution
by communicating results.
The co-design process of HAITooL
followed the strategy of well-adjust-
ing with the background where the system was being
implemented (e.g. integrating national health director-
ate antibiotic guidelines and meeting local perceived
needs) [13].
The HAITooL decision-support systems proves to be
of major importance to best manage patient safety, for
medical work quality improvement.The main findings,
achievements and milestones, are as following:
1. At an early stage, we understood that the problem
was originated on infection control team work over-
load, with time-consuming tasks, dealing with all the
ward organization complexity, and experiencing dif-
ficulty in accessing evidence-based information, real-
time [9].
2. An initial survey participants, gave major relevance
to the need for better access to hospital antibiotic sus-
ceptibility patterns and epidemiological data, among
other pertinent daily information (e.g. clinical and
pharmaceutical data) [11].
3. As learnt from best-practices’ benchmark, of the
infection control teams of Norway, Switzerland and
others, including national ones, surveillance and clini-
cal decision-support systems have the potential to
enhance ASP, by improving HP access to validated in-
formation [14]. Pharmaceutical, microbiological, and
clinical data, integrated all together within one main
system, the HAITooL, offer all the participants the pos-
sibility of giving their inputs, review clinical and tech-
nical information and participate actively throughout
the entire process, on the behalf of patient’s security
and work quality improvement.
4. With web-services or views in place, HAITooL
Fig.2 -
HAITooL collaborative team.