Vol.74 No.4 July 2026

Changes in inpatient antibiotic use following a nudge-based electronic medical record intervention using the WHO AWaRe classification

Ryuichi Oku^{1, 2)}, Mika Yanagihara^{1, 2)}, Junko Nakabayashi^{1, 3)}, Kumiko Takahashi^{1, 4)}, Sanae Sota¹⁾, Yasuhiko Yokoyama^{1, 5)} and Yoshiro Hadano^{1, 6)}

¹⁾Antimicrobial stewardship team, Matsue Seikyo General Hospital, 8-8-8 Nishitsuda, Matsue City, Shimane, Japan
²⁾Department of Pharmacy, Matsue Seikyo General Hospital
³⁾Department of Nursing, Matsue Seikyo General Hospital
⁴⁾Department of Clinical Laboratory, Matsue Seikyo General Hospital
⁵⁾Department of Surgery, Matsue Seikyo General Hospital
⁶⁾Division of Infection Control and Prevention, Shimane University Hospital

Abstract

This study was aimed at evaluating the impact of an electronic medical record-based, nudge-oriented intervention incorporating the World Health Organization AWaRe classification on inpatient antibiotic use and antimicrobial susceptibility patterns. The intervention consisted of disseminating printed materials outlining the AWaRe classification and reimbursement requirements for antimicrobial stewardship, and configuring the prescribing interface to display AWaRe categories. The intervention was implemented in May 2024, and changes in antibiotic use pre- and post-intervention were assessed using median with interquartile ranges over 8 months before and after the intervention.
After the intervention, the proportion of Access antibiotics increased from 32.7% to 38.0% (p=0.021), whereas the proportion of Watch antibiotics decreased from 66.1% to 61.0% (p=0.038). The proportion of Reserve antibiotics decreased from 1.2% to 0.8%, which was not statistically significant (p=0.370), while that of Not Recommended antibiotics decreased from 0.3% to 0.0% (p=0.001). In regard to antibiotics used against Pseudomonas aeruginosa, the bacterial susceptibility to antipseudomonal agents varied across drug classes; significant decreases were observed for cefepime and tazobactam/piperacillin, whereas stable or improved susceptibility trends were observed for carbapenems.
These findings suggest that integrating AWaRe classification information into the electronic prescribing system as a nudge-based intervention may promote more appropriate inpatient antibiotic use.

Key word

AWaRe classification, electronic medical record, nudge, antimicrobial stewardship team, Pseudomonas aeruginosa

Received

January 21, 2026

Accepted

March 26, 2026

Jpn. J. Chemother. 74 (4): 473-481, 2026