72 / 105
72
Notas de Investigação
gather the data into a single database, organized by sever-
al pre-selected indicators. HAITooL includes
integrated
views of patient, microbiology and pharmacy data, dis-
played in innovative layouts and graphics.Visualization of
patient clinical evolution, antibiotic consumption trends,
antibiotic resistant infections distribution, and local an-
timicrobial susceptibility patterns turns to be easy and
clear for the professional.The display of alerts, for exam-
ple in cases of excessive antimicrobial therapy duration
and antimicrobial therapy not in accordance with micro-
biology results, among others, helps the decision-maker.
5. In HAITooL’s implementation first steps, it already
could provide the HAI’s information management for
the involved hospitals, with implemented evidence-
based practices and teamwork techniques, aligned with
the objectives of the National Program for Prevention
and Control of Infections and Antimicrobial Resistance,
in Portugal.
6. The system architecture and the DSRM framework
for intervention, enables its implementation in other set-
tings. HAITooL information system is now being devel-
oped in CapeVerde main hospitals.
The HP’s change of work habits, through education and
organizational policies and measures is happening by im-
proving HP’s confidence in prescribing antibiotics and
making control decisions.The surveillance and decision-
support system could be an effective anchor to improve
their work quality. The implementation of a new infor-
mation system should have in account the HP relation-
ship either with the information and communication
technologies (ICT) and with the decision and prescribing
tasks’ changing [15].
The information system development has considered the
key-elements of anASP (Figure 3) to be able to: (a) mon-
itor antibiotic consumption; (b) monitor antibiotic resis-
tant bacteria; (c) promote antibiotic prescription based
on laws and main guidelines; (d) improve physicians’
prescription behavior. All the key-elements are consid-
ered to be essential. However, if we cannot ensure conti-
nuity of action and participation of the first two - Lead-
ership Commitment and MultidisciplinaryTeam - all the
process stays at risk.The role of informaticians was also
of major importance, often the major bottleneck.
During each process of implementation, there were ob-
served important barriers at the different levels of lead-
ership power and collaboration (e.g. the recurrent lack
of available time, the lack of human resources within the
hospitals, bureaucratic authorizations delays, among oth-
ers).
The co-design process was a good instrument to main-
tain everyone engaged, and to find time to work in the
system.Those are examples of implementation obstacles
often blocking the process of system evolution, threaten-
ing the final product delivery, and risking to be a demo-
tivating factor.
It is vital to guarantee multidisciplinary and full engage-
ment at all implementation levels to address all the criti-
cal factors, where human variables must be considered.
Continuous communication is paramount. Managers are
key in promoting the engagement of all participants.
Conclusion
HAITooL is important to enable effective monitoring of
antibiotic resistance and antibiotic use, and helps antibi-
otic prescription, strengthening the HP work capacity.
The design, development, implementation and evalua-
tion process reveals benefits in organizational and behav-
ior change. The close collaboration with clinicians, the
Infection and Prevention
Control Team, physi-
cians, nurses, pharma-
cists, microbiologists
and ICT technicians,
under a participative
approach, was the base-
line for a successful im-
plementation.
All the key-elements
for an ASP are impor-
tant, but the leadership
commitment, multi-
disciplinary team and
mainly informaticians’
engagement are crucial
to the implementation
process.
When overcoming the
Fig.3 -
Key-elements for HAITooLASP [8].