Participatory Development of a 2.0 Platform to implement an International Antibiotic Stewardship Program

Background: To reduce the risks resistant bacteria pose to patient safety, more prudent use of antibiotics both in and outside care facilities is needed. Our literature review shows that there is a lack of available, usable, and tailored information on antibiotic use in public health and care facilities. Antibiotic Stewardship Programs (ASPs) have been proposed and implemented--mainly in hospitals--to facilitate physicians in prescribing the right antimicrobial drug for an appropriate amount of time. Hereby, cost-savings and increases in patient safety can be accomplished. According to the literature, ASPs need to be based on international standards that are applied in care facilities based on local resistance patterns and resources. An ASP should be carried out by multidisciplinary teams that provide caregivers with evidence-based feedback. Implementation includes educational activities, reminders, decision support, and patient education. Technology-based interventions can support the development and implementation process. The effects of ASPs are promising, but a lack of awareness, knowledge, acceptance, adherence and ownership hinder implementation. Therefore, we apply a holistic approach to develop a 2.0 platform that fits with its 'users' and supports the implementation of ASPs.The objective is to develop a user-friendly and feasible 2.0 platform including ASP-application aimed at increasing patient safety.Methods: A holistic development of the 2.0 platform and ASP application, integrating Human Centered Design and Business Modeling. Key-stakeholders (patients, caregivers, decision-makers) participate during the development process to identify needs (contextual inquiry), demands and critical issues for implementation (value creation) and to prototype concepts (co-design). This leads to business models for the operationalization (effects on costs, health outcomes). First we developed the 2.0 basic infection control platform that supports communication and information. Scenarios and mock-ups were discussed via stakeholder-interviews (physicians, nurses, pharmacists, patients). These interviews ground the development of the 2.0 platform and its ASP application. Workshops following this approach are carried out between May and June 2011. In interactive stakeholder workshops we use critical incidence techniques to perform the contextual inquiry and value creation. With the end-users, the resulting functional requirements are translated into a technology design. Via stakeholder participation business models are created for the operationalization of the ASP in practice.Results: Participatory development resulted in a 2.0 infection control platform that enables communication, documentation and information exchange regarding infection control. The platform can be used as an information source, but more importantly, it supports the stakeholder needs of cooperation and interaction through information-sharing applications such as social media, a forum, document upload, and the interactive ASP application that is being developed. A working prototype of the ASP application that is part the platform will be realized this summer. The design of the ASP application will be co-created with the end-users, the exact functionalities and features depend on the research outcomes. The 2.0 platform and its applications are not technology-driven but stakeholder-driven, facilitating implementation and uptake.Conclusion: Based on previous experiences and first results it is expected that the participatory development of the platform renders commitment, adherence to guidelines, cost reductions, and thereby improves patient safety.