A digital clinical decision support tool has improved antibiotic prescribing in Western Australian country hospitals where it has been adopted, although an independent evaluation found nearly three-quarters of health service sites had little or no sustained use.
The University of Technology Sydney (UTS) evaluation of Antimicrobial Pathways (AMPS), based on Kraken Coding’s Clinical Branches platform, found prescribing appropriateness improved by 20.8 percentage points and compliance with clinical guidelines by 21.8 percentage points at adopter hospitals compared with non-adopter sites.
However, 49 of the 68 WA Country Health Service (WACHS) sites examined recorded no or minimal use of the tool, while only nine demonstrated strong or sustained uptake.
The evaluation analysed 39,805 AMPS pathways between 2023 and 2025 and compared 3917 audited antibiotic prescriptions across three adopter and five non-adopter hospitals.
Researchers also interviewed 30 clinicians and other stakeholders to assess how the technology was being used and identify barriers to adoption.
UTS senior lecturer in health services management Dr Sarah Wise said the results demonstrated the potential of digital decision support to improve antibiotic prescribing in rural and remote settings.
“In hospitals where the tool was adopted, the evaluation found an improvement of nearly 21 per cent in prescribing antibiotics according to clinical guidelines,” Dr Wise said.
“In resource-constrained settings where access to specialist advice and timely pathology can be limited, that is a really important step forward.”
AMPS translates antimicrobial prescribing guidelines into step-by-step clinical decision support, taking account of patient characteristics and local antimicrobial resistance patterns.
The tool is designed to help clinicians make prescribing decisions where specialist infectious diseases advice may be difficult to access.
WACHS chief pharmacist Jonathan Nugent said the technology provided locally relevant guidance at the point of care.
“It provides timely, specialist-informed and locally relevant guidance at the point of care, supporting safe and appropriate prescribing,” Mr Nugent said.
“What makes it particularly valuable is that the guidance is tailored to where you’re working.”
The evaluation found uptake was strongest in smaller and more remote services, with pharmacists and senior prescribers among the most prominent users.
Staff generally reported confidence in the tool, but limited awareness, insufficient training, workforce turnover and difficulties accessing the system prevented more consistent use.
The researchers identified three priorities for wider implementation: incorporating AMPS into routine staff orientation and education, simplifying access and integration with clinical systems and embedding its use in antimicrobial stewardship activities.
Kraken Coding co-founder John Shanks said the evaluation highlighted the importance of implementation support.
“UTS showed us what adoption takes: clinicians trusted the tool, and the gaps were awareness, onboarding and access, which gives us a clear plan,” Mr Shanks said.
“In busy health settings, with high staff turnover and multiple systems competing for attention, getting people to consistently use a new tool takes ongoing support.”
The project was funded by the Digital Health Cooperative Research Centre in partnership with WACHS and Kraken Coding.
Add Comment