Journal articles on the topic 'Antimicrobial stewardship; Antimicrobials; hospital pharmacists'
To see the other types of publications on this topic, follow the link: Antimicrobial stewardship; Antimicrobials; hospital pharmacists.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Antimicrobial stewardship; Antimicrobials; hospital pharmacists.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Hamada, Yukihiro, Fumiya Ebihara, and Ken Kikuchi. "A Strategy for Hospital Pharmacists to Control Antimicrobial Resistance (AMR) in Japan." Antibiotics 10, no. 11 (October 21, 2021): 1284. http://dx.doi.org/10.3390/antibiotics10111284.
Full textAbstract:
In Japan, there is concern regarding the relation between the inappropriate use of antibiotics and antibiotic resistance (AMR). Increased bacterial resistance is due in part to the inappropriate use of antimicrobial agents. The support of the pharmacist becomes important, and there is growing interest in antimicrobial stewardship to promote the appropriate and safe use of antimicrobials needed for the optimal selection of drugs, doses, durations of therapy, therapeutic drug monitoring (TDM), and implementations of cost containment strategies in Japan. Pharmacists should strive to disseminate the concept of “choosing wisely” in relation to all medicines, implement further interventions, and put them into practice. In this article, we present data for antimicrobial stewardship and Japan’s AMR action plan, focusing on how pharmacists should be involved in enabling physicians to choose antimicrobials wisely.
2
Shealy, Stephanie, Joseph Kohn, Emily Yongue, Casey Troficanto, Brandon Bookstaver, Julie A. Justo, Michelle Crenshaw, Hana Winders, Sangita Dash, and Majdi Al-Hasan. "Motivational Application of Standardized Antimicrobial Administration Ratios Within a Healthcare System." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s321. http://dx.doi.org/10.1017/ice.2020.918.
Full textAbstract:
Background: Hospitals in the United States have been encouraged to report antimicrobial use (AU) to the CDC NHSN since 2011. Through the NHSN Antimicrobial Use Option module, health systems may compare standardized antimicrobial administration ratios (SAARs) across specific facilities, patient care locations, time periods, and antimicrobial categories. To date, participation in the NHSN Antimicrobial Use Option remains voluntary and the value of reporting antimicrobial use and receiving monthly SAARs to multihospital healthcare systems has not been clearly demonstrated. In this cohort study. we examined potential applications of SAAR within a healthcare system comprising multiple local hospitals. Methods: Three hospitals within Prisma Health-Midlands (hospitals A, B, and C) became participants in the NHSN Antimicrobial Use Option in July 2017. SAAR reports were presented initially in October 2017 and regularly (every 3–4 months) thereafter during interprofessional antimicrobial stewardship system-wide meetings until end of study in June 2019. Through interfacility comparisons and by analyzing SAAR categories in specific patient-care locations, primary healthcare providers and pharmacists were advised to incorporate results into focused antimicrobial stewardship initiatives within their facility. Specific alerts were designed to promote early de-escalation of antipseudomonal β-lactams and vancomycin. The Student t test was used to compare mean SAAR in the preintervention period (July through October 2017) to the postintervention period (November 2017 through June 2019) for all antimicrobials and specific categories and locations within each hospital. Results: During the preintervention period, mean SAAR for all antimicrobials in hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Notably, mean SAARs at hospitals A, B, and C in intensive care units (ICU) during the preintervention period were 0.67, 1.36, and 0.83 for broad-spectrum agents used for hospital-onset infections and 0.59, 1.27, and 0.68, respectively, for agents used for resistant gram-positive infections. After antimicrobial stewardship interventions, mean SAARs for all antimicrobials in hospital B decreased from 1.09 to 0.83 in the postintervention period (P < .001). Mean SAARs decreased from 1.36 to 0.81 for broad-spectrum agents used for hospital-onset infections and from 1.27 to 0.72 for agents used for resistant gram-positive infections in ICU at hospital B (P = .03 and P = .01, respectively). No significant changes were noted in hospitals A and C. Conclusions: Reporting AU to the CDC NHSN and the assessment of SAARs across hospitals in a healthcare system had motivational effects on antimicrobial stewardship practices. Enhancement and customization of antimicrobial stewardship interventions was associated with significant and sustained reductions in SAARs for all antimicrobials and specific antimicrobial categories at those locations.Funding: NoneDisclosures: None
3
Lai, Wan Mae, Farida Hanim Islahudin, Rahela Ambaras Khan, and Wei Wen Chong. "Pharmacists’ Perspectives of Their Roles in Antimicrobial Stewardship: A Qualitative Study among Hospital Pharmacists in Malaysia." Antibiotics 11, no. 2 (February 9, 2022): 219. http://dx.doi.org/10.3390/antibiotics11020219.
Full textAbstract:
Antimicrobial resistance has negatively impacted patient outcomes and increased healthcare costs. Antimicrobial stewardship (AMS) includes all activities and policies to promote the judicious use of antimicrobials. Pharmacists are key players in AMS models worldwide. However, there is a research gap in the role of pharmacists as antimicrobial stewards in Malaysia. This study aimed to explore hospital pharmacists’ perspectives on their roles in, and barriers and facilitators to the implementation of AMS strategies. Individual, semi-structured interviews were conducted with 16 hospital pharmacists involved in AMS activities from 13 public hospitals in Kuala Lumpur and Selangor. Audio-taped interviews were transcribed verbatim and imported into NVivo software version 10.0 (QSR). A thematic analysis method was used to identify themes from the qualitative data until theme saturation was reached. Respondents perceived pharmacists as having important roles in the implementation of AMS strategies, in view of the multiple tasks they were entrusted with. They described their functions as antimicrobial advisors, antimicrobial guardians and liaison personnel. The lack of resources in terms of training, manpower and facilities, as well as attitudinal challenges, were some barriers identified by the respondents. Administrative support, commitment and perseverance were found to be facilitators to the role of pharmacists in AMS. In conclusion, pharmacists in public hospitals play important roles in AMS teams. This study has provided insights into the support that AMS pharmacists in public hospitals require to overcome the barriers they face and to enhance their roles in the implementation of AMS strategies.
4
Bulger, Peter, Alyssa Y. Castillo, John B. Lynch, John B. Lynch, Paul Pottinger, Jeannie D. Chan, Rupali Jain, Mandana Naderi, Zahra Kassamali, and Chloe Bryson-Cahn. "133. A Review of Antimicrobial Formularies at Rural Hospitals: Stewardship Opportunities Abound." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S179. http://dx.doi.org/10.1093/ofid/ofab466.335.
Full textAbstract:
Abstract Background Management of a hospital’s antimicrobial formulary is an important aspect of antimicrobial stewardship and cost containment strategies. Ensuring that essential medications for clinical care are available and excluding therapeutic duplicates and unnecessary antimicrobials is time and resource intensive. Comparisons of antimicrobial formularies across multiple rural hospitals have not been evaluated in the literature. We hypothesized that a comprehensive formulary evaluation would reveal important opportunities for antimicrobial stewardship efforts and could help smaller hospitals optimize available medications. Methods The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) is comprised of 68 hospitals of varying sizes, most of which are rural and critical access, in Washington, Oregon, Arizona, Idaho, and Utah. We surveyed UW-TASP participating hospitals and other networked rural hospitals in multiple Western states using REDCap, a HIPAA-compliant, electronic data management program. Respondents reported which antimicrobials are on their hospital formulary as well as basic information about hospital size and inpatient units. Data were reviewed by a panel of infectious diseases trained physicians and pharmacists at UW-TASP. Results Surveys from 49 hospitals were received; two were excluded from the data analysis (Table 1) – one submission was incomplete, and one was a large inpatient psychiatric hospital. Select antimicrobials and proportion of hospitals carrying these agents is shown in Table 2. Several antimicrobials are on the formulary at all hospitals, regardless of size. In some critical access hospitals (< 25 beds), empiric first-line bacterial meningitis and viral encephalitis coverage (Table 3) was lacking. Six hospitals (12.7%) lacked ampicillin for Listeria coverage and only one had a suitable alternative agent (meropenem). Seven hospitals (14.9%) lacked intravenous acyclovir, although three had oral valacyclovir. Formulary inclusion of agents for multi-drug resistant organisms was rare. Conclusion In critical access hospitals in the Western USA, lack of essential empiric antimicrobials may be more of a concern than inclusion of agents with unnecessarily broad spectra. Disclosures Chloe Bryson-Cahn, MD, Alaska Airlines (Other Financial or Material Support, Co-Medical Director, position is through the University of Washington)
5
Rubin, Ellen C., Alison L. Blackman, Eleanor K. Broadbent, David Wang, Ilda Plasari, Pawlose Ketema, Karrine Brade, and Tamar F. Barlam. "103. Expansion of an Antimicrobial Stewardship Program Through Implementation of a Discharge Verification Queue." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S166. http://dx.doi.org/10.1093/ofid/ofab466.305.
Full textAbstract:
Abstract Background Antimicrobial stewardship programs (ASPs) have traditionally focused interventions on inpatient care to improve antibiotic prescribing. Support of effective interventions for ASPs targeting antibiotic prescriptions at hospital discharge is emerging. Our objective was to expand stewardship services into the outpatient setting through implementation of a process by the antimicrobial stewardship team (AST) to verify antimicrobials prescribed at discharge. Methods This quality improvement initiative incorporated a discharge order verification queue managed by AST pharmacists to review electronically prescribed antimicrobials Monday through Friday, from 8:00 am to 4:00 pm. The queue was piloted Sep 2020 and expanded hospital-wide Feb 2021. Patients < 18 years old and those with observation or emergency department status were excluded. The AST pharmacist reviewed discharge prescriptions for appropriateness, intervened directly with prescribers, and either rejected or verified prescriptions prior to transmission to outpatient pharmacies. Complicated cases were reviewed with the AST physician to evaluate intervention appropriateness. Interventions were categorized as either dose adjustment, duration, escalation or de-escalation, discontinuation, or safety monitoring. Results A total of 602 prescriptions were reviewed between Sep 2020 and Apr 2021. An AST pharmacist intervened on 28% (171/602) of prescriptions. The most common intervention types were duration (41%, 70/171), discontinuation (18%, 31/171), and dose adjustment (17%, 30/171). The most common indications in which the duration was shortened was community acquired pneumonia (26%, 18/70), skin and soft tissue infection (21%, 15/70), and urinary tract infection (17%, 12/70). The most common antibiotics recommended for discontinuation were cephalexin (32%, 10/31) and trimethoprim-sulfamethoxazole (10%, 3/31). The overall intervention acceptance rate was 78%. Conclusion An AST pharmacist review of antimicrobial prescriptions at discharge improved appropriate prescribing. The discharge queue serves as an effective stewardship strategy for inpatient ASPs to expand into the outpatient setting. Disclosures All Authors: No reported disclosures
6
MacDougall, Conan, and Ron E. Polk. "Antimicrobial Stewardship Programs in Health Care Systems." Clinical Microbiology Reviews 18, no. 4 (October 2005): 638–56. http://dx.doi.org/10.1128/cmr.18.4.638-656.2005.
Full textAbstract:
SUMMARY Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources.
7
Bishop, Bryan M. "Antimicrobial Stewardship in the Emergency Department." Journal of Pharmacy Practice 29, no. 6 (July 8, 2016): 556–63. http://dx.doi.org/10.1177/0897190015585762.
Full textAbstract:
Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance.
8
Tauman, Allison V., Ari Robicsek, Joyce Roberson, and John M. Boyce. "Health Care-Associated Infection Prevention and Control: Pharmacists' Role in Meeting National Patient Safety Goal 7." Hospital Pharmacy 44, no. 5 (May 2009): 401–11. http://dx.doi.org/10.1310/hpj4405-401.
Full textAbstract:
Health care-associated infections and antimicrobial resistance are continually increasing, with fewer drugs available for effective treatment. Potential benefits of infection control and antimicrobial stewardship programs include improvements in antibiotic use and conversion from intravenous (IV) to oral antibiotics and reductions in resistance and infection rates and length of hospital stay. NorthShore University HealthSystem in Evanston, Illinois, was the first large hospital system in North America that adopted universal inpatient surveillance for methicillin-resistant Staphylococcus aureus (MRSA). Results showed that nasal MRSA was a powerful predictor of MRSA disease and antibiotic resistance in other organisms. MRSA infections occurring up to 30 days posthospitalization decreased by approximately 70%. At the Hospital of Saint Raphael, a community teaching hospital in New Haven, Connecticut, an antimicrobial stewardship pilot program focused on automatic conversation from IV to oral antimicrobials and appropriate antimicrobial use. The percentage of patients receiving oral fluconazole increased from 63% to 77%; the percentage of those receiving oral linezolid increased from 54% to 71%. Total antibiotic use decreased by 6%. Based on the 60-day trial, potential cost savings were estimated as $874,000 annually, less the cost of a pharmacist's salary and benefits. Infection control and antimicrobial stewardship programs offer pharmacists new opportunities for helping improve patient safety and quality of care. Pharmacy-medical staff partnership, combined with support from microbiology, infection control, information technology, and hospital administration, is key to a successful program.
9
Beaulieu, Ronald, Milner Staub, Thomas Talbot, Matthew Greene, Gowri Satyanarayana, Patty Wright, Whitney Nesbitt, Amy Myers, and George Nelson. "Implementation of a Resource-Efficient Indirect Handshake Stewardship Model at an Academic Medical Center." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s272. http://dx.doi.org/10.1017/ice.2020.841.
Full textAbstract:
Background: Handshake antibiotic stewardship is an effective but resource-intensive strategy for reducing antimicrobial utilization. At larger hospitals, widespread implementation of direct handshake rounds may be constrained by available resources. To optimize resource utilization and mirror handshake antimicrobial stewardship, we designed an indirect feedback model utilizing existing team pharmacy infrastructure. Methods: The antibiotic stewardship program (ASP) utilized the plan-do-study-act (PDSA) improvement methodology to implement an antibiotic stewardship intervention centered on antimicrobial utilization feedback and patient-level recommendations to optimize antimicrobial utilization. The intervention included team-based antimicrobial utilization dashboard development, biweekly antimicrobial utilization data feedback of total antimicrobial utilization and select drug-specific antimicrobial utilization, and twice weekly individualized review by ASP staff of all patients admitted to the 5 hospitalist teams on antimicrobials with recommendations (discontinuation, optimization, etc) relayed electronically to team-based pharmacists. Pharmacists were to communicate recommendations as an indirect surrogate for handshake antibiotic stewardship. As reviewer duties expanded to include a rotation of multiple reviewers, a standard operating procedure was created. A closed-loop communication model was developed to ensure pharmacist feedback receipt and to allow intervention acceptance tracking. During implementation optimization, a team pharmacist-champion was identified and addressed communication lapses. An outcome measure of days of therapy per 1,000 patient days present (DOT/1,000 PD) and balance measure of in-hospital mortality were chosen. Implementation began April 5, 2019, and data were collected through October 31, 2019. Preintervention comparison data spanned December 2017 to April 2019. Results: Overall, 1,119 cases were reviewed by the ASP, of whom 255 (22.8%) received feedback. In total, 236 of 362 recommendations (65.2%) were implemented (Fig. 1). Antimicrobial discontinuation was the most frequent (147 of 362, 40.6%), and most consistently implemented (111 of 147, 75.3%), recommendation. The DOT/1,000 PD before the intervention compared to the same metric after intervention remained unchanged (741.1 vs 725.4; P = .60) as did crude in-hospital mortality (1.8% vs 1.7%; P = .76). Several contributing factors were identified: communication lapses (eg, emails not received by 2 pharmacists), intervention timing (mismatch of recommendation and rounding window), and individual culture (some pharmacists with reduced buy-in selectively relayed recommendations). Conclusion: Although resource efficient, this model of indirect handshake did not significantly impact total antimicrobial utilization. Through serial PDSA cycles, implementation barriers were identified that can be addressed to improve the feedback process. Communication, expectation management, and interpersonal relationship development emerged as critical issues contributing to poor recommendation adherence. Future PDSA cycles will focus on streamlining processes to improve communication among stakeholders.Funding: NoneDisclosures: None
10
Yeoh, Kim, Catherine George, and Kirsty Buising. "Improving Patient Knowledge and Understanding of Their Antimicrobial Therapy: An Antimicrobial Stewardship Intervention." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s289. http://dx.doi.org/10.1017/ice.2020.863.
Full textAbstract:
Background: The Australian Antimicrobial Stewardship Clinical Care Standard states that patients should receive information about their antimicrobial therapy, including their indication, how and when to take them, their duration, and potential side effects. The level of information provided to hospital inpatients about their prescribed antimicrobial therapy is not well understood. Our objective was to evaluate whether adult inpatients received specific information about their antimicrobials in accordance with antimicrobial stewardship clinical care standards, to identify any gaps that needed to be addressed. Methods: Patients receiving 1 or more antimicrobials for >72 hours who were admitted on an acute or subacute ward were recruited. A survey tool was designed and conducted to establish the current status of information provision to patients. The information gathered was used to develop and deliver activities and resources to facilitate better communication about antimicrobial therapy. Results: In total, 54 patients were surveyed. Most patients (83%) were informed that they were taking antimicrobials, and of these, 96% said they knew the indication, 18% were informed of potential side effects, and 36% knew the duration. Only 22% were informed of the review plan, and only 27% knew whether antimicrobials would be continued on discharge. Written information was given to 11% of patients. Over half of these patients (56%) either wanted more information or had concerns about their antimicrobials. Patients reported difficulty in obtaining information with some receiving information via “word-of-mouth from other patients.” Moreover, 58% of patients received antimicrobial information from doctors, 13% from nurses, and 12% from pharmacists. However, most patients stated that they expected information from all 3 professional groups. In response to these survey findings, a focus group of antimicrobial stewardship experts was convened to discuss methods of improving delivery of information to patients regarding their antimicrobial therapy. We undertook nursing education to empower nurses to discuss information about antimicrobials with their patients, and we developed consumer information sheets. Conclusions: More needs to be done to inform patients about the antimicrobials used in their treatments to empower them to participate in their treatment. This factor will be the focus of future antimicrobial stewardship interventions.Funding: NoneDisclosures: None
11
Dempsey, Casey J., Natasha Weiner, Michele Riccardi, and Kristin Linder. "83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S58—S59. http://dx.doi.org/10.1093/ofid/ofaa439.128.
Full textAbstract:
Abstract Background Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital. Methods A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI). Results Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p < 0.001), ciprofloxacin (23.22 vs. 9.97; p < 0.001), levofloxacin (11.2 vs. 5.07; p < 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p < 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p < 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p < 0.001), levofloxacin ($2,168 vs. $672; p < 0.001), ciprofloxacin ($6,700 vs. $1,954; p < 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p < 0.001). Conclusion Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives. Disclosures All Authors: No reported disclosures
12
Wong, Lok Hang, Evonne Tay, Shi Thong Heng, Huiling Guo, Andrea Lay Hoon Kwa, Tat Ming Ng, Shimin Jasmine Chung, Jyoti Somani, David Chien Boon Lye, and Angela Chow. "Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis." Antibiotics 10, no. 12 (November 24, 2021): 1441. http://dx.doi.org/10.3390/antibiotics10121441.
Full textAbstract:
Antimicrobial stewardship programmes (ASPs) in hospitals are predominantly led by specific ASP physicians and pharmacists. Limited studies have been conducted to appreciate non-ASP-trained hospital pharmacists’ perspectives on their roles in antimicrobial stewardship. Focus group discussions (FGDs) were conducted with 74 pharmacists, purposively sampled from the 3 largest acute-care public hospitals in Singapore, to explore facilitators and barriers faced by them in antimicrobial stewardship. Applied thematic analysis was conducted and codes were categorised using the social–ecological model (SEM). At the intrapersonal level, pharmacists identified themselves as reviewers for drug safety before dispensing, confining to a restricted advisory role due to lack of clinical knowledge, experience, and empowerment to contribute actively to physicians’ prescribing decisions. At the interpersonal level, pharmacists expressed difficulties conveying their opinions and recommendations on antibiotic therapy to physicians despite frequent communications, but they assumed critical roles as educators for patients and their caregivers on proper antibiotic use. At the organisational level, in-house antibiotic guidelines supported pharmacists’ antibiotic interventions and recommendations. At the community level, pharmacists were motivated to improve low public awareness and knowledge on antibiotic use and antimicrobial resistance. These findings provide important insights into the gaps to be addressed in order to harness the untapped potential of hospital pharmacists and fully engage them in antimicrobial stewardship.
13
Otieno, Phanice Ajore, Sue Campbell, Sonny Maley, Tom Obinju Arunga, and Mitchel Otieno Okumu. "A Systematic Review of Pharmacist-Led Antimicrobial Stewardship Programs in Sub-Saharan Africa." International Journal of Clinical Practice 2022 (October 13, 2022): 1–16. http://dx.doi.org/10.1155/2022/3639943.
Full textAbstract:
Background. The misuse of antibiotics contributes significantly to antimicrobial resistance (AMR). Higher treatment costs, longer hospital stays, and clinical failure can all result from AMR. According to projections, Africa and Asia will bear the heaviest burden of AMR-related mortalities in the coming years. Antimicrobial stewardship (AMS) programmes are therefore critical in mitigating the effects of AMR. Pharmacists may play an important role in such programmes, as seen in Europe and North America, but the impact, challenges, and opportunities of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan African hospitals are unknown. The purpose of this systematic review was to assess the impact, challenges, and opportunities of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan African hospitals. Methods. The Joanna Briggs Institute (JBI) guidelines were used to search for peer-reviewed pharmacist-led studies based in hospitals in Sub-Saharan Africa that were published in English between January 2015 and January 2021. The PubMed, Embase, and Ovid databases were used. Results. Education and training, audits and feedback, protocol development, and ward rounds were identified as primary components of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan Africa. The pharmacist-led antimicrobial interventions improved adherence to guidelines and reduced inappropriate prescribing, but were hampered by a lack of laboratory and technological support, limited stewardship time, poor documentation, and a lack of guidelines and policies. Funding, mentorship, guidelines, accountability, continuous monitoring, feedback, multidisciplinary engagements, and collaborations were identified as critical in the implementation of pharmacist-led antimicrobial stewardship programmes. Conclusions. These findings suggest that pharmacists in Sub-Saharan African hospitals can successfully lead antimicrobial stewardship programmes but their implementation is limited by lack of mentorship, accountability, continuous monitoring, feedback, collaborations, and poor funding.
14
Medler, Corey, Nicholas Mercuro, Nancy MacDonald, Allison Weinmann, Melinda Neuhauser, Lauri Hicks, Arjun Srinivasan, George Divine, Marcus Zervos, and Susan Davis. "Implementation Methods for a Collaborative Pharmacist-Led Antimicrobial Stewardship Intervention at Hospital Discharge." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s268—s269. http://dx.doi.org/10.1017/ice.2020.838.
Full textAbstract:
Background: Unnecessary and prolonged antibiotic use is an important driver of antimicrobial resistance, increasing patient harm and resource utilization. Antimicrobials prescribed at hospital discharge represent an important opportunity to intervene and optimize therapy. Objective: We describe the implementation of a pharmacist-led multidisciplinary antimicrobial stewardship (AMS) intervention at transition of care (TOC) to improve antibiotic selection and duration. Methods: This intervention an IRB-approved multihospital, quasi-experimental, 3-phase stepped-wedge project in a 5-hospital health system. The setting included a large, urban, academic medical center in Detroit, Michigan, and 4 community hospitals in southeastern Michigan. AMS is provided by a pharmacist and infectious diseases physician at each site. For the AMS TOC intervention, pharmacists implemented 3 strategies: (1) early identification of patients to be discharged on oral antibiotics; (2) collaborative planning and communication regarding guideline-recommended antibiotic selection and duration; and (3) facilitation of discharge antibiotic prescription with appropriate stop date. Process improvements were modified to fit the academic and community hospital practice models. The process was implemented in general and specialty practice wards at each hospital site. Prior to implementation in October 2018, pharmacists were trained on tools to standardize identification, collaboration, and documentation. Pocket cards were used to augment education and electronic medical record (EMR) templates standardized documentation. Physicians and nurses on participating units were educated on the rationale and process. Following initiation, ongoing feedback was provided regularly to pharmacists to discuss challenges and to identify solutions. Process measures included the total number of patients receiving the intervention monthly, as indicated by pharmacist AMS TOC notes placed. Protocol adherence was evaluated in 25 randomly selected patients in each study phase each month. Adherence was defined as a pharmacist preparing discharge prescriptions and a placing note in the EMR. Results: Over the study period, 1,558 patient encounters received AMS TOC facilitation by a pharmacist. Monthly protocol adherence ranged from 29% to 87% (higher in academic institutions than community) (Fig. 1). Months of low protocol adherence were associated with times of reduced staffing and onboarding a large group of new employees or trainees. Additional barriers included discharges over weekends. The most common area needing clarification was how to count days of therapy to determine the appropriate stop date. A guide of how to count days of therapy was created to assist. Conclusions: Pharmacist-led antimicrobial stewardship at discharge is a feasible intervention in both academic and community settings. Identifying potential barriers and assessing strategies with multidisciplinary healthcare teams allows for optimal implementation and intervention rollout.Funding: This work was completed under CDC contract number 200-2018-02928.Disclosures: None
15
Pourgolafshan, Pegah, Ivan Ying, and Danny Chen. "1988. Impact of a Novel Pharmacist Practice Model on Antimicrobial Usage and Hospital-acquired Clostridium difficile (HACDI) Rates." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S666—S667. http://dx.doi.org/10.1093/ofid/ofz360.1668.
Full textAbstract:
Abstract Background The Antimicrobial Stewardship Program (ASP) was implemented at our 425-bed community hospital in June of 2012. The ASP team, 1 pharmacist, and 1 infectious diseases physician reviewed all intensive care patients on antimicrobials as well as patients on select broad-spectrum antibiotics. In 2016, ASP expansion was undertaken without additional staffing using a novel unit pharmacist model. The effectiveness of in-house antimicrobial stewardship (AMS) training programs for unit pharmacists is not well described. We report the impact of our model on antimicrobial usage and HACDI rates. Methods In 2016, an extensive AMS training and certification program was developed for all unit pharmacists. The program consisted of learning modules, didactic lectures, competency assessments, and individual teaching by the ASP team. In 2017, the practice model was rolled out and the ASP team met with each pharmacist biweekly to review prospective audit and feedback cases with a focus on ceftriaxone and fluoroquinolones. Antimicrobial usage was tracked by defined daily doses (DDD) per 1,000 patient-days, as defined by the World Health Organization. HACDI rates per 1,000 patient-days were defined by the Ontario Ministry of Health and Long Term Care. Results Since the model launched in 2017 until March of 2019, total antimicrobial usage was decreased by 22% (P < 0.001), fluoroquinolones by 21% (P = 0.01), and ceftriaxone by 53% (P < 0.001). HACDI rates decreased from 0.30 to 0.16 cases per 1,000 patient-days (47%, P = 0.12) (Figure 1). Since ASP implementation in 2012, total antimicrobial usage has been reduced by 35% (P < 0.01), fluoroquinolones by 73% (P < 0.001), clindamycin by 70% (P = 0.05) and rates of HACDI by 73% (P < 0.0001) (Figure 2). Pseudomonas susceptibility rates improved (2012 vs. 2017) for meropenem (86% to 93%), ciprofloxacin (73% to 90%), and piperacillin–tazobactam (80 to 92%), but did not reach statistical significance. Conclusion To the best of our knowledge, this is the first description in the literature of an in-house AMS training and certification program for unit pharmacists and its impact on clinical outcomes. This novel approach creates a sustainable and staffing neutral practice model that effectively reduces unnecessary antimicrobial usage and HACDI, resulting in improved patient safety. Disclosures All authors: No reported disclosures.
16
Avent, Minyon L., Lisa Hall, Louise Davis, Michelle Allen, Jason A. Roberts, Sean Unwin, Kylie A. McIntosh, Karin Thursky, Kirsty Buising, and David L. Paterson. "Antimicrobial stewardship activities: a survey of Queensland hospitals." Australian Health Review 38, no. 5 (2014): 557. http://dx.doi.org/10.1071/ah13137.
Full textAbstract:
Objective In 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommended that all hospitals in Australia must have an Antimicrobial Stewardship (AMS) program by 2013. Nevertheless, little is known about current AMS activities. This study aimed to determine the AMS activities currently undertaken, and to identify gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. Methods The AMS activities of 26 facilities from 15 hospital and health services in Queensland were surveyed during June 2012 to address strategies for effective AMS: implementing clinical guidelines, formulary restriction, reviewing antimicrobial prescribing, auditing antimicrobial use and selective reporting of susceptibility results. Results The response rate was 62%. Nineteen percent had an AMS team (a dedicated multidisciplinary team consisting of a medically trained staff member and a pharmacist). All facilities had access to an electronic version of Therapeutic Guidelines: Antibiotic, with a further 50% developing local guidelines for antimicrobials. One-third of facilities had additional restrictions. Eighty-eight percent had advice for restricted antimicrobials from in-house infectious disease physicians or clinical microbiologists. Antimicrobials were monitored with feedback given to prescribers at point of care by 76% of facilities. Deficiencies reported as barriers to establishing AMS programs included: pharmacy resources, financial support by hospital management, and training and education in antimicrobial use. Conclusions Several areas for improvement were identified: reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use. There also appears to be a lack of resources to support AMS programs in some facilities. What is known about the topic? The ACSQHC has recommended that all hospitals implement an AMS program by 2013 as a requirement of Standard 3 (Preventing and Controlling Healthcare-Associated Infections) of the National Safety and Quality Health Service Standards. The intent of AMS is to ensure appropriate prescribing of antimicrobials as part of the broader systems within a health service organisation to prevent and manage healthcare-associated infections, and improve patient safety and quality of care. This criterion also aligns closely with Standard 4: Medication Safety. Despite this recommendation, little is known about what AMS activities are undertaken in these facilities and what additional resources would be required in order to meet these national standards. What does the paper add? This is the first survey that has been conducted of public hospital and health services in Queensland, a large decentralised state in Australia. This paper describes what AMS activities are currently being undertaken, identifies practice gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. What are the implications for practitioners? Several areas for improvement such as reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use have been identified. In addition, there appears to be a lack of resources to support AMS programs in some facilities.
17
Mercuro, Nicholas, Corey Medler, Nancy MacDonald, Rachel Kenney, Melinda Neuhauser, Lauri Hicks, Arjun Srinivasan, George Divine, Marcus Zervos, and Susan Davis. "Improving Prescribing Practices at Hospital Discharge With Pharmacist-Led Antimicrobial Stewardship at Transitions of Care." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s289—s290. http://dx.doi.org/10.1017/ice.2020.864.
Full textAbstract:
Background: Antimicrobial stewardship (AMS) is recommended in hospital, postacute, and outpatient settings. Transitions of care (TOC) are important in each of these settings; however, AMS efforts during TOC have been limited. Beginning in October 2018, we sequentially implemented a pharmacist-led multidisciplinary review of oral antimicrobial therapy prescribed at hospital discharge from general and specialty medicine wards across a health system. Pharmacists facilitated data input of discharge prescriptions following early identification and collaborative discussion of patients to be discharged on oral antimicrobials The purpose of this study was to evaluate the impact of AMS during TOC. Methods: This project was an IRB-approved stepped-wedge, quasi-experimental study in a 5-hospital health system that included hospitalized adults with skin, urinary, intra-abdominal, and respiratory tract infections who had been discharged from general and specialty wards with oral antimicrobials. Patients with complicated infections, neutropenia, or who were transferred from an outside hospital were excluded. The primary end point was optimization of antimicrobial therapy at time of hospital discharge, defined by correct selection, dose, and duration according to institutional guidance. Outcomes were compared before and after the intervention. Results: In total, 800 patients were included: 400 in the preintervention period and 400 in the postintervention period. Among this cohort, 252 (63%) received the intervention by a pharmacist per protocol during TOC. Patients had similar comorbid conditions before and after the intervention. Preintervention patients were more likely to be discharged from community hospitals. Before the intervention, 36% of discharge regimens were considered optimized, compared to 81.5% after the intervention (P < .001); this difference was largely driven by a reduction in patients receiving a duration of therapy beyond the clinical indication (44.5 vs 10%; P < .001). We observed similar clinical resolution, 30-day readmission, and adverse drug events (ADEs) between the pre- and postintervention periods. Postdischarge antimicrobial duration of therapy was reduced from 4 days (range, 3–5) to 3 days (range, 2–4) (P < .001) Severe ADEs occurred more frequently in the preintervention group (9 vs 3.3%; P = .001), which was driven by isolation of multidrug-resistant pathogens (7 vs 2.5%; P = .003) and Clostridioides difficile (1.8 vs 0.5%; P = .094). Patients who received optimal therapy at discharge were less likely to develop an ADE (aOR, 0.530; 95% CI, 0.363–0.773). Conclusions: Implementation of an AMS TOC protocol reduced antimicrobial days, optimized therapy selection, and reduced duration. This intervention was associated with improved safety without compromise of clinical effectiveness. To increase patient safety, AMS programs should target antimicrobial optimization during TOC.Funding: This work was completed under CDC contract number 200-2018-02928.Disclosures: None
18
McCort, Margaret E., Rachel Bartash, Kelsie Cowman, Susan Sakalian, Carol Sheridan, Karen Wright, Una T. Hopkins, Priya Nori, and Priya Nori. "161. Assessing Antimicrobial Stewardship Engagement among Frontline Oncology Nurses and Chartering a Path Forward." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S90. http://dx.doi.org/10.1093/ofid/ofaa439.206.
Full textAbstract:
Abstract Background Developing robust, multidisciplinary antimicrobial stewardship programs to combat drug resistance is a priority of healthcare institutions, in accordance with Joint Commission standards and national legislature. However, the involvement of nurses in stewardship programs has trailed behind that of physicians and pharmacists, despite their unique position as frontline providers. In particular, oncology nursing staff can play a key role in extending stewardship to their high acuity patients, who frequently require antimicrobials. We sought to conduct a survey study of oncology nursing providers on their understanding, perceptions, and attitudes about antimicrobial stewardship. Methods A voluntary and anonymous survey was emailed to oncology nursing staff on adult and pediatric oncology wards and clinics throughout our hospital system. We used an adapted 28-item Likert scale-based survey to assess understanding of antimicrobial stewardship attitudes and perceived barriers to greater involvement in stewardship programs. A survey reminder was emailed weekly for 8 weeks and completion was encouraged by nursing leadership in unit staff meetings. Results The survey was emailed to 281 nurses, of whom 39% (n=109) responded. 54.1% of nurses believed that an antibiotic stewardship program was very important in their healthcare setting. However, 56% of respondents were unfamiliar with the meaning of antibiotic stewardship, and 83.5% were not aware of how to contact the antimicrobial stewardship team with questions. More than 75% felt that nurses could help with antibiotic use, though 76% indicated wanting to know more about which antibiotics treat different infections and 74% wanted to know more about appropriate durations of antibiotics. Conclusion Oncology nurses have the potential to play a valuable role in antimicrobial stewardship. Barriers to nursing involvement include knowledge gaps on antibiotics and unfamiliarity with existing stewardship programs and their functions within hospital systems. Nursing education and orientation to available resources are key steps to involving nursing staff in antimicrobial stewardship programs, maximizing benefits for both patients and hospitals. Disclosures All Authors: No reported disclosures
19
Erickson, Amy K. "Hospital pharmacists are essential to antimicrobial stewardship." Pharmacy Today 22, no. 8 (August 2016): 6–7. http://dx.doi.org/10.1016/j.ptdy.2016.07.003.
Full text
20
Minor, Sarah Brooks, Kelly D. Rafferty, Julia Rutkowski, Steven Allison, and Victor Herrera. "1071. Implementation and Impact of an Antimicrobial Tier Structure Along with Prospective Audit and Feedback at a Large Health System: Collaborations for Care Transformation." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S379—S380. http://dx.doi.org/10.1093/ofid/ofz360.935.
Full textAbstract:
Abstract Background Antibiotic overuse continues to be a challenge in the acute care setting. At AdventHealth Orlando (AHO), pharmacy-led prospective audit with feedback (PAAF) has been the primary stewardship tool. Despite PAAF and criteria for use, overall utilization of high-cost, broad-spectrum agents continues to increase. Recently, the Antimicrobial Stewardship Awareness Program (ASAP) employed transformation medical directors (TMDs) and, along with the pharmacy team, developed a novel concept using an antimicrobial tier structure, in addition to historical PAAF. The purpose was to assess the impact of the tier structure, along with PAAF performed by the pharmacists and TMDs, compared with PAAF alone. Methods This retrospective pre (March–August 2018)- and post (October 2018–March 2019) implementation study was conducted at AHO. The ASAP team developed a hospital-wide policy listing antimicrobials based on a tier system (Figure 1), with higher priority agents falling in tiers 3 (T3) and 4 (T4). Education was completed in September 2018 and the process was implemented in October 2018. Criteria for use was evaluated at the point of order entry, followed by PAAF by the pharmacist and TMD. The primary outcome was impact on T3 and T4 antimicrobial utilization, measured in days of therapy (DOT) per 1,000 days present (DP). Secondary outcomes included T3 and T4 antimicrobial cost/adjusted patient-days and rates of hospital-acquired C. difficile infections (CDI). Results During the post-implementation period, the average DOT per 1,000 DP for T3 and T4 agents decreased by 21.3% (89 vs. 70, P = 0.001) compared with the pre-implementation period (Figure 2). Average T3 and T4 antimicrobial costs decreased by 26% during the post-implementation period ($9.83 vs. $7.27, P < 0.001). Additionally, rates of hospital-acquired CDI decreased by 14% (P = 0.41) during the post-implementation period. Conclusion The tier concept, along with PAAF collaborations between the pharmacists and TMD, allowed for a greater impact on antimicrobial utilization, compared with pharmacist-led PAAF alone. In addition to significant decrease in antimicrobial utilization, substantial cost-savings were demonstrated. A nonsignificant declining trend in the incidence of hospital-acquired CDI was also noted during the post-implementation period. Disclosures All authors: No reported disclosures.
21
Junior, Adelino Freire, Fernando Fagundes, Mozar Castro Neto, Carine Barbosa, and Thais Alves. "Evaluation of Initial Outcomes of an Antimicrobial Stewardship Program in a Nonprofit Hospital in Brazil." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s228—s229. http://dx.doi.org/10.1017/ice.2020.775.
Full textAbstract:
Background: One of the main global public health challenges is the fight against microbial resistance, according to the World Health Organization. Inadequate use of antimicrobials is considered one of the main factors related to the phenomenon and is quite common in the hospital environment. Managing the use of antimicrobials in hospitals has become a necessity and has shown positive results in many ways, such as maximizing the effects of pharmacotherapy, preventing the emergence of resistant microorganisms, and reducing healthcare costs. Methods: The prescriptions for patients admitted to a 380-bed nonprofit private hospital in Belo Horizonte, Brazil were monitored from January 1, 2019, to August 31, 2019, with a monthly average of 251 patients followed by the antimicrobial stewardship (AMS) team (1 infectious diseases doctor and 2 clinical pharmacists). Patients selected for follow-up and intervention were those submitted to intravenous, intramuscular, and/or oral antibiotic therapy with the following antimicrobial agents: piperacillin/tazobactam, carbapenem, polymyxin B, tigecycline, vancomycin, teicoplanin, daptomycin, third- and fourth-generation cephalosporins, quinolone, and aminoglycosides. Patients on prophylactic or antimicrobial treatment not mentioned above were excluded from surveillance. Interventions were dose adjustments, drug adjustment by culture results, intravenous to oral treatment switch, and discontinuation of therapy. Results: There were 318 interventions, and 64.82% of the interventions performed by the AMS team were accepted by prescribers. The interventions provided a total savings of BR$ 119,706 (~US$30,000) in direct antimicrobial spending. Correlating the interventions with the defined daily dose (DDD) measurement and comparing data from the same period in 2018, we detected a reductions in the consumption of several antimicrobials: ceftriaxone (25.6%), ciprofloxacin (45.7%), meropenem (34%), piperacillin/tazobactam (12.7%), teicoplanin (18.8%), vancomycin (20.6%), cefepime (23.9%) and polymyxin B (26%). We also detected reductions in days of therapy (DOT) for most of these drugs, such as polymyxin B, with an average reduction of 2 DOT. Conclusions: Reducing antimicrobial use is one of the key strategies for avoiding unnecessary exposure and selective pressure leading to the emergence of resistant microorganisms. The measured data point to a favorable trend in the rational use of antimicrobials in our institution with simple interventions. The results presented were used to reaffirm the importance of the AMS team in our institution. More data on length of stay, indirect costs, reduction of side effects, mortality, and occurrence of microbial resistance should be made.Funding: NoneDisclosures: None
22
Alawi, Maha Mahmoud, Wail A. Tashkandi, Mohamed A. Basheikh, Faten M. Warshan, Hazem Ahmed Ghobara, Rosemarie B. Ramos, Mary Leilani Guiriba, et al. "Effectiveness of Antimicrobial Stewardship Program in Long-Term Care: A Five-Year Prospective Single-Center Study." Interdisciplinary Perspectives on Infectious Diseases 2022 (April 12, 2022): 1–12. http://dx.doi.org/10.1155/2022/8140429.
Full textAbstract:
Objective. To report the effectiveness of the antimicrobial stewardship program (ASP) in a long-term care (LTC) facility, by analyzing the change in antimicrobial consumption and cost and multidrug resistance (MDR) rates over a 5-year period. Method. A prospective interventional study was conducted at a 106-bed facility (nursing home: 100 beds and an intensive care unit (ICU): 6 beds). The ASP was designed and led by a multidisciplinary team including an infectious disease consultant, two clinical pharmacists, a clinical microbiologist, and an infection control preventionist. Five key performance indicators were monitored: (1) intravenous (IV)-to-oral switch rate, (2) consumption of restricted IV antimicrobials (raw consumption and defined daily doses (DDD) index), (3) cost of restricted IV antimicrobials, (4) antimicrobial sensitivity profiles, and (5) MDR rate among hospital-acquired infections (MDR-HAI). Result. A ∼5.5-fold enhancement of the IV-to-oral switch and a 40% reduction in the overall consumption of restricted IV antimicrobials were observed. Regarding the cost, the cumulative cost saving was estimated as 5.64 million SAR (US$1.50 million). Microbiologically, no significant change in antimicrobial sensitivity profiles was observed; however, a large-size reduction in the MDR-HAI rate was observed, notably in ICU where it declined from 3.22 per 1,000 patient days, in 2015, to 1.14 per 1,000 patient days in 2020. Interestingly, the yearly overall MDR rate was strongly correlated with the level of antimicrobial consumption. Conclusion. The implementation of a multidisciplinary ASP in LTC facilities should be further encouraged, with emphasis on physicians’ education and active involvement to enhance the success of the strategy.
23
Cheah, Ron, Arjun Rajkhowa, Rodney James, Kym Wangeman, Sonia Koning, Karin Thursky, and Kirsty Buising. "Case for antimicrobial stewardship pharmacy technicians in Australian hospitals." Australian Health Review 44, no. 6 (2020): 941. http://dx.doi.org/10.1071/ah19236.
Full textAbstract:
The pharmacist’s role in hospital antimicrobial stewardship (AMS) programs is known to improve patient safety and the quality of care. Despite this, many Australian hospitals struggle to provide adequate pharmacy AMS program resourcing and need to explore newer models of care. The Pharmacy Board of Australia’s Guidelines for Dispensing Medicines permit suitably qualified, competent and experienced pharmacy technicians to assist pharmacists in ‘tasks in a pharmacy department’. The pharmacy technician workforce is expanding, and there is growing interest in career advancement and expansion of the pharmacy technician role. We propose that the pharmacy technician, a well-integrated member of many Australian hospital pharmacy departments, can play an important role in hospital AMS programs. To bolster AMS initiatives in Australian hospitals, this paper explores the existing evidence for pharmacy technicians in AMS programs and describes how this role may be better supported in Australia.
24
Suh, Yewon, Young-Mi Ah, Ha-Jin Chun, Su-Mi Lee, Hyung-sook Kim, Hyun-Jun Gu, A.-Jeong Kim, et al. "Potential Impact of the Involvement of Clinical Pharmacists in Antimicrobial Stewardship Programs on the Incidence of Antimicrobial-Related Adverse Events in Hospitalized Patients: A Multicenter Retrospective Study." Antibiotics 10, no. 7 (July 14, 2021): 853. http://dx.doi.org/10.3390/antibiotics10070853.
Full textAbstract:
Although specialized pharmacists have been suggested to be essential members of antimicrobial stewardship programs (ASPs), not all hospitals in Korea operate ASPs with pharmacists involved. We aimed to evaluate the association of involvement of clinical pharmacists as team members of multidisciplinary ASPs with the incidence of antimicrobial-related adverse drug events (ADEs). Five tertiary teaching hospitals participated in this retrospective cohort study. At each participating hospital, we randomly selected 1000 participants among patients who had received systemic antimicrobial agents for more than one day during the first quarter of 2017. We investigated five categories of antimicrobial-related ADEs: allergic reactions, hematologic toxicity, nephrotoxicity, hepatotoxicity, and antimicrobial-related diarrhea. Multivariate logistic regression analysis was used to evaluate the potential impact of pharmacist involvement in ASPs on the incidence of ADEs. A total of 1195 antimicrobial-related ADEs occurred in 618 (12.4%) of the 4995 patients included in the analysis. The overall rate of ADE occurrence was 17.4 per 1000 patient days. Hospitals operating ASPs with pharmacists showed significantly lower AE incidence proportions than other hospitals (8.9% vs. 14.7%; p < 0.001). Multidisciplinary ASPs that included clinical pharmacists reduced the risk of antimicrobial-related ADEs by 38% (adjusted odds ratio 0.62; 95% confidence interval 0.50–0.77). Our results suggest that the active involvement of clinical pharmacists in multidisciplinary ASPs may contribute to reduce the incidence of antimicrobial-related ADEs in hospitalized patients.
25
Traynor, Kate. "Hospital pharmacists take time out for antimicrobial stewardship." American Journal of Health-System Pharmacy 73, no. 24 (December 15, 2016): 2030–34. http://dx.doi.org/10.2146/news160075.
Full text
26
Parsels, Katie A., Wesley D. Kufel, Jeni Burgess, Robert Seabury, Rahul Mahapatra, Christopher Miller, and Jeffrey M. Steele. "41. Impact of Discharge Antimicrobial Stewardship at an Academic Medical Center." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S142. http://dx.doi.org/10.1093/ofid/ofab466.243.
Full textAbstract:
Abstract Background The Centers for Disease Control and Prevention estimates approximately 30% of antimicrobials prescribed in the outpatient setting are unnecessary and up to 50% are inappropriate. Despite this, antimicrobial stewardship (AS) efforts mostly focus on the inpatient setting and limited data describe AS interventions at hospital discharge. Acknowledging the potential for discharge AS, we used our existing resources to review discharge antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy to potentially optimize antimicrobial therapy. Methods Discharge antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy, reviewed by an infectious disease (ID) pharmacist, and recorded into the REDCap® data collection tool from September 1, 2020 to February 28, 2021 were evaluated retrospectively. Both adult and pediatric patients were included. The primary outcome was to identify the frequency a DRP was identified by an ID pharmacist while reviewing discharge antimicrobial prescriptions. Secondary outcomes included DRP characterization, percentage of prescriptions with interventions, intervention acceptance rate, and the reduction in antimicrobial days dispensed at discharge when interventions to limit treatment duration were accepted. Results Of the 803 discharge antimicrobial prescriptions reviewed, at least one DRP was identified in 43.1% (346/803). The most frequently identified DRPs pertained to treatment duration, drug selection, and dose selection. The most common intervention categories included different antimicrobial duration, antimicrobial discontinuation, and different dose or frequency. At least one intervention was recommended in 42.8% (344/803) of prescriptions. In total, 438 interventions were made and the acceptance rate was 75.6% (331/438). When interventions to reduce the treatment duration were accepted, the median (interquartile range) number of antimicrobial days decreased from 8 (5 – 10) to 4 (0 – 5.5) days (P < 0.001). Conclusion ID pharmacist review of discharge antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy resulted in identification of DRPs and subsequent interventions in a substantial number of prescriptions. Disclosures Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)
27
Albahar, Fares, Hamza Alhamad, Rana K. Abu-Farha, Husam Alsalamat, Deema Jaber, and Abla M. Albsoul-Younes. "Electronic Prescribing System and electronic health record priorities for antimicrobial stewardship." Jordan Journal of Pharmaceutical Sciences 15, no. 1 (March 1, 2022): 107–20. http://dx.doi.org/10.35516/jjps.v15i1.298.
Full textAbstract:
Rationale, aims, and objectives: This study provided a platform for electronic prescribing design features that may facilitate antimicrobial stewardship. This study aimed to identify software features within electronic prescribing systems and to assign priorities to these software features according to the opinions of the infection specialist health care professionals. Also, to identify any differences in priorities according to a professional group and experience in using electronic prescribing and communicate research findings to policy-makers and electronic prescribing manufacturers.
Methods: The study was conducted in a large (600-bed) governmental tertiary and teaching hospital in Amman, Jordan. The survey was delivered by hand to antimicrobial prescribers (internists, surgeons, paediatricians, infectious diseases specialists, and critical care specialists) and non-prescribers (medical interns, clinical pharmacists, nurses, and other allied health care professionals) who filled out the survey face to face. The delivery of the survey started on March 15, 2020, and was closed on April 7, 2020.
Results: Responses were received from 210 individuals. Interns represented more than one-third of respondents (n= 79, 37.6%), with 15.7% were internal medicine physicians. Among the healthcare professionals, around 44.7% (n= 94) are considered prescribers to antimicrobials, while others are considered non-prescribers (n= 116, 55.2%). The majority of respondents (n= 205, 97.6%) reported using an electronic prescribing and electronic health record system for part or all in their hospital, with 35.7% (n= 75) of them reported using these systems for more than one year. The prompt prescribing feature having the highest assigned priority was the allergy checker (n= 193, 91.9%) followed by the dose checker (n= 192, 91.4%).
Conclusion: This study demonstrates the first attempt to describe views of healthcare professionals in Jordan about the potential significance of prescribing prompt and active prescription surveillance software features on clinical, microbiological and process outcomes to support antimicrobial stewardship. Findings from this study reveal considerable demand for additional software features expressed by the healthcare professionals charged with promoting rational use of antimicrobials and a consensus of anticipated positive impact on patient safety and efficiency outcomes.
28
Jones, Justin M., Nathan D. Leedahl, Ashley Losing, Paul J. Carson, and David D. Leedahl. "A Pilot Study for Antimicrobial Stewardship Post-Discharge: Avoiding Pitfalls at the Transitions of Care." Journal of Pharmacy Practice 31, no. 2 (March 27, 2017): 140–44. http://dx.doi.org/10.1177/0897190017699775.
Full textAbstract:
Purpose: Lack of patient follow-up is a major concern during care transitions, and the role of an antimicrobial stewardship program (ASP) in assessing antimicrobial regimens after hospital discharge is not well described. We implemented an expanded ASP to include patients recently discharged from the hospital and measured its impact on inappropriate antimicrobial therapy 72 hours after inpatient culture data were finalized. Methods: A prospective cohort study was conducted at a 583-bed tertiary care center in the Upper Midwest of America. All patients discharged from our facility on antimicrobial therapy with pending culture results between February 3, 2016, and March 2, 2016, were included for review. If a pathogen nonsusceptible to all prescribed antimicrobials was identified post-discharge, a recommendation for therapy modification was communicated to the prescriber. Results: Thirty-eight patients discharged from our hospital on antimicrobial therapy with pending culture results were evaluated for intervention. When final culture susceptibilities were considered, 5 of 38 patients had been prescribed an inappropriate antimicrobial agent. An ASP pharmacist intervened on 4 of 5 patients, resulting in 3 of 5 patients transitioning to appropriate antimicrobial therapy. When compared to a historical cohort, our transitions-of-care ASP yielded a 3.6-fold increase in antimicrobial-related interventions among discharged patients while reducing inappropriate outpatient antimicrobial therapy by 39%. Conclusion: We believe this is the first pharmacist-driven ASP represented in the medical literature which evaluated all available inpatient culture data to serve patients discharged from the hospital. Antimicrobial stewardship for patients in care transitions may provide an opportunity to increase ASP interventions and reduce inappropriate antimicrobial therapy.
29
Szymczak, Julia, Keith Hamilton, Jeffrey Gerber, Maryrose Laguio-Vila, Zanthia Wiley, Mary Elizabeth Sexton, Alice Guh, Sujan Reddy, and Ebbing Lautenbach. "An Interactive Sociotechnical Analysis of the Implementation of Electronic Decision Support in Antimicrobial Stewardship." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s115—s116. http://dx.doi.org/10.1017/ice.2020.622.
Full textAbstract:
Background: There is great enthusiasm for the potential of decision support tools embedded in the electronic medical record to improve antimicrobial use in hospitals. Yet they are often limited in their ability to change prescriber behavior. Analyzing these tools using an interactive sociotechnical approach (ISTA) can identify barriers and facilitators to the implementation of electronic decision support (EDS) in antimicrobial stewardship. Objective: To examine prescriber and antimicrobial steward perceptions of EDS using an ISTA approach in the preimplementation phase of an antimicrobial stewardship intervention. Methods: We conducted semistructured interviews with prescribers and stewards from 4 hospitals in 2 health systems in the context of a multicomponent intervention to improve the use of fluoroquinolones and extended-spectrum cephalosporins. Sites planned to implement various EDS elements including order sets, antimicrobial time outs, and audit with feedback stewardship notes in the medical record. Interviews elicited respondent perceptions about the planned intervention. Two analysts systematically coded transcripts using an ISTA framework in NVivo12 software. Results: Interviews with 64 respondents were conducted: 38 physicians, 7 nurses, 6 advanced practice providers, and 13 pharmacists. We identified 4 key sociotechnical interaction types likely to influence stewardship EDS implementation. First, EDS changes the communication patterns and practices of antimicrobial stewards in a way that improves efficiency but decreases vital social interaction with prescribers to facilitate behavior change. Second, there is a gap between what stewards envision for EDS and that which is possible to build in a timely manner by hospital information technology specialists. As a result, there is often a months- to years-long delay from proposal to implementation, which negatively affects intervention acceptance. Third, prescribers expressed great enthusiasm for stewardship EDS that would simplify their workload, allow them to complete important work tasks, and save time. They strongly objected to stewardship EDS that was disruptive without a compelling purpose or did not integrate smoothly with pre-existing technology infrastructure. Fourth, physician prescribers attributed social and emotional meaning to stewardship EDS, suggesting that these tools can undermine professional authority, autonomy, and confidence. Conclusions: Implementing stewardship EDS in a way that improves the use of antimicrobials while minimizing unintended negative consequences requires attention to the interplay between new EDS and an organization’s existing workflow, culture, social interactions and technologies. Implementing EDS in stewardship will require attention to these domains to realize the full potential of these tools and to avoid negative unintended consequences.Funding: NoneDisclosures: None
30
Buckel, Whitney R., Jared Olson, Adam Hersh, Michelle Matheu, and Edward A. Stenehjem. "2059. Antimicrobial Stewardship of Community Parenteral Antimicrobial Therapy: A Health System Approach." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S694. http://dx.doi.org/10.1093/ofid/ofz360.1739.
Full textAbstract:
Abstract Background Community parenteral antimicrobial therapy (CoPAT) allows patients to receive intravenous (IV) antimicrobials outside the hospital; however, inappropriate use occurs and can lead to adverse outcomes. In addition, these patients are at high risk of readmission. Our objective was to assess the quality of CoPAT in a large healthcare system in order to guide implementation of an intervention requiring mandatory review by antimicrobial stewardship. Methods We identified patients with orders for IV antimicrobials at discharge between January 1 and December 10, 2018. Patients were excluded if transferred to an acute care facility, left against medical advice, or died. 250 patients were selected using a random number generator and reviewed consecutively until 100 confirmed CoPAT encounters were identified. Each encounter was evaluated for evidence of ID consultation, opportunities for stewardship interventions in seven categories (See Table 1), and adverse events such as emergency room (ER) visits and readmissions. Results The query identified 4,642 potential CoPAT discharges from 22 hospitals (see Table 2). 117 encounters were reviewed to reach 100 true CoPAT discharges (85% query accuracy). Of these, 55 (55%) received a formal ID consult, 6 (6%) had an ID pharmacist or ID physician curbside, and 5 (5%) had an ID clinic follow-up appointment scheduled without formal ID consult. Opportunity for stewardship intervention was found in 50 (50%) patients (see Table 1). There were 31 (31%) patients who were seen in the ER (n = 21) and/or re-admitted (n = 19) to the hospital during or shortly after completion of CoPAT, of which 25 (81%) were potentially related to CoPAT, including abnormal laboratory findings, PICC-line complications, and signs or symptoms of infection. Conclusion CoPAT patients are complex with high healthcare utilization. Mandatory ID review of patients receiving CoPAT has the potential to impact 2,000 lives annually in a large health system. Disclosures All authors: No reported disclosures.
31
Shively, Nathan R., Matthew A. Moffa, Kathleen T. Paul, Eric J. Wodusky, Beth Ann Schipani, Susan L. Cuccaro, Mark S. Harmanos, Michael S. Cratty, Bruce N. Chamovitz, and Thomas L. Walsh. "Impact of a Telehealth-Based Antimicrobial Stewardship Program in a Community Hospital Health System." Clinical Infectious Diseases 71, no. 3 (September 5, 2019): 539–45. http://dx.doi.org/10.1093/cid/ciz878.
Full textAbstract:
Abstract Background Data on antimicrobial stewardship programs (ASPs) facilitated via telehealth in the community hospital setting are limited. Methods A telehealth-based ASP was implemented in 2 community hospitals (285 and 176 beds). Local pharmacists without residency or prior antimicrobial stewardship training were trained to conduct prospective audit and feedback. For approximately 60 minutes 3 times weekly at the 285-bed hospital and 2 times weekly at the 176-bed hospital, infectious diseases (ID) physicians remotely reviewed patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft tissue infections with local pharmacists. Recommendations for ASP interventions made by ID physicians were relayed to primary teams and tracked by local pharmacists. Antimicrobial utilization was collected in days of therapy (DOT) per 1000 patient-days (PD) for a 12-month baseline and 6-month intervention period, and analyzed with segmented linear regression analysis. Local ID consultations were tracked and antimicrobial cost savings were estimated. Results During the 6-month intervention period, 1419 recommendations were made, of which 1262 (88.9%) were accepted. Compared to the baseline period, broad-spectrum antibiotic utilization decreased by 24.4% (342.1 vs 258.7 DOT/1000 PD; P < .001) during the intervention period. ID consultations increased by 40.2% (15.4 consultations per 1000 PD vs 21.5 consultations per 1000 PD; P = .001). Estimated annualized savings on antimicrobial expenditures were $142 629.83. Conclusions An intense ASP model, facilitated in the community hospital setting via telehealth, led to reduced broad-spectrum antimicrobial utilization, increased ID consultations, and reduced antimicrobial expenditures.
32
Brady PharmD, Jeanne, and Mahendra Poudel. "1068. Implementation of an Antimicrobial Stewardship Program (ASP) Managed by an Infectious Disease Physician and Pharmacists in a Community Hospital." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S378—S379. http://dx.doi.org/10.1093/ofid/ofz360.932.
Full textAbstract:
Abstract Background The implementation of antimicrobial stewardship program (ASP) is one of the basis for the control of multidrug-resistant bacteria (MDR), optimization of antibiotic use, minimization of adverse events, and reduction of unnecessary costs. We demonstrate the design, development, and participation in ASP program following CDC and Prevention Core Elements strategies.1,3,4 The objective is to evaluate the impact of clinical pharmacists working in conjunction with infectious disease (ID) physician on tracking and documenting antibacterial utilization in per patient-days, pharmacist clinical interventions, prescriber practices, and antibiotic purchases. Methods We conducted a multidisciplinary-team project of pharmacist-led prospective-audit-with-feedback ASP from 2015 to 2018. The ID physician and clinical pharmacist conducted patient care rounds twice weekly to make recommendations that include de-escalation, intensification of treatment, alternative therapy, dose optimization, order clarification, stop date/duration, additional monitoring, education, restriction enforcement, consult, IV to PO conversion, rejection of recommendation, and total monitored interventions requiring no changes. Results Pharmacist tracked between 150 and 200 interventions monthly through the EMR system, reflecting both self-stewardship and during rounds with ID physician. Figures 2–8: Charts display the number of patient-days of therapy per 1,000 days at risk and yearly SVMH Antibacterial Utilization Rates compared nationally to other Teaching and Nonteaching hospitals.5 Below each graph exhibits yearly Drug Spend per patient-days of Therapy.6 Conclusion Overall, the antibiotic utilization rates decreased over 4 years, particularly with aztreonam, meropenem, and levofloxacin.The formalization of an antimicrobial stewardship partnership between ID physician and pharmacy team led to increases in pharmacist-recommended interventions, streamlining of antimicrobial therapy, as well as decreases in antimicrobial purchasing costs. Proactively working in conjunction with hospitalists allows the pharmacists to play a critical role in sustaining a robust ASP service at our community hospital. The ASP at SVMH can serve as a model for other community hospitals with similar resources. Disclosures All authors: No reported disclosures.
33
Olaoye, Omotayo, Chloe Tuck, Wei Ping Khor, Roisin McMenamin, Luke Hudson, Mike Northall, Edwin Panford-Quainoo, Derrick Mawuena Asima, and Diane Ashiru-Oredope. "Improving Access to Antimicrobial Prescribing Guidelines in 4 African Countries: Development and Pilot Implementation of an App and Cross-Sectional Assessment of Attitudes and Behaviour Survey of Healthcare Workers and Patients." Antibiotics 9, no. 9 (August 29, 2020): 555. http://dx.doi.org/10.3390/antibiotics9090555.
Full textAbstract:
Smartphone apps have proven to be an effective and acceptable resource for accessing information on antimicrobial prescribing. The purpose of the study is to highlight the development and implementation of a smartphone/mobile app (app) for antimicrobial prescribing guidelines (the Commonwealth Partnerships for Antimicrobial Stewardship—CwPAMS App) in Ghana, Tanzania, Uganda and Zambia and to evaluate patients’ and healthcare providers’ perspectives on the use of the App in one of the participating institutions. Two structured cross-sectional questionnaires containing Likert scale, multiple-choice, and open-ended questions were issued to patients and healthcare workers six months after the introduction of the app at one of the hospital sites. Metrics of the use of the app for a one-year period were also obtained. Download and use of the app peaked between September and November 2019 with pharmacists accounting for the profession that the most frequently accessed the app. More than half of the responding patients had a positive attitude to the use of the app by health professionals. Results also revealed that more than 80% of health care workers who had used the CwPAMS App were comfortable using a smartphone/mobile device on a ward round, considered the app very useful, and found it to improve their awareness of antimicrobial stewardship, including documentation of the indication and duration for antimicrobials on the drug chart. It also encouraged pharmacists and nurses to challenge inappropriate antimicrobial prescribing. Overall, our findings suggest that its use as a guide to antimicrobial prescribing sparked positive responses from patients and health professionals. Further studies will be useful in identifying the long-term consequences of the use of the CwPAMS App and scope to implement in other settings, in order to guide future innovations and wider use.
34
Jokanovic, Natali, Terry Haines, Allen C. Cheng, Kathryn E. Holt, Sarah N. Hilmer, Yun-Hee Jeon, Andrew J. Stewardson, et al. "Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial." BMJ Open 11, no. 3 (March 2021): e046142. http://dx.doi.org/10.1136/bmjopen-2020-046142.
Full textAbstract:
IntroductionAntimicrobial resistance is a growing global health threat, driven by increasing inappropriate use of antimicrobials. High prevalence of unnecessary use of antimicrobials in residential aged care facilities (RACFs) has driven demand for the development and implementation of antimicrobial stewardship (AMS) programmes. The Stepped-wedge Trial to increase antibiotic Appropriateness in Residential aged care facilities and model Transmission of antimicrobial resistance (START) will implement and evaluate the impact of a nurse-led AMS programme on antimicrobial use in 12 RACFs.Methods and analysisThe START trial will implement and evaluate a nurse-led AMS programme via a stepped-wedge cluster randomised controlled trial design in 12 RACFs over 16 months. The AMS programme will incorporate education, aged care-specific treatment guidelines, documentation forms, and audit and feedback strategies that will target aged care staff, general practitioners, pharmacists, and residents and their families. The intervention will primarily focus on urinary tract infections, lower respiratory tract infections, and skin and soft tissue infections. RACFs will transition from control to intervention phases in random order, two at a time, every 2 months, with a 2-month transition, wash-in period. The primary outcome is the cumulative proportion of residents within each facility prescribed an antibiotic during each month and total days of antibiotic use per 1000 occupied bed days. Secondary outcomes include the number of courses of systemic antimicrobial therapy, antimicrobial appropriateness, antimicrobial resistant organisms, Clostridioides difficile infection, change in antimicrobial susceptibility profiles, hospitalisations and all-cause mortality. Analyses will be conducted according to the intention-to-treat principle.Ethics and disseminationEthics approval has been granted by the Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/591). Research findings will be disseminated through peer-reviewed publications, conferences and summarised reports provided to participating RACFs.Trial registration numberNCT03941509.
35
Oppong, K. G., J. Attakorah, A. Enimil, C. Ansah, and K. O. Buabeng. "Antibiotic Stewardship and Its Impact on Antibiotic Use at The Child Health Directorate of A Teaching Hospital In Ghana." AFRICAN JOURNAL OF APPLIED RESEARCH 8, no. 2 (November 7, 2022): 322–31. http://dx.doi.org/10.26437/ajar.31.10.2022.22.
Full textAbstract:
Purpose: The study was intended to ascertain the existence of an antibiotic stewardship programme at the Child Health Directorate of Komfo Anokye Teaching Hospital (KATH) and assess the knowledge of health professionals about the importance of the antimicrobial stewardship programme. Again, it sort to assess the experience of participants with pharmacotherapy of infections and patient outcomes with generic and innovative brands of antibiotics. The third was to assess reporting on adverse reactions and storage conditions of the antibiotics.
Design/Methodology/ Approach: This was a cross-sectional study involving health professionals who participated in the provision of infectious disease management services.
Findings: Eighty-eight (88) professionals were involved in the study, comprising nurses (n=51), medical doctors (n=21), pharmacists (n=8), biomedical scientists (n=5) and public health officers (n=3). No antibiotic stewardship programme existed. However, there was a protocol for antibiotic use that was not strictly adhered to. About 60 % of the participants had knowledge of the antibiotic stewardship programme and affirmed its importance. The majority (75 %, n=66) reported treatment failure with generic brands of antibiotics compared to innovator brands. Thirty-four percent of the participants (n=30) reported adverse drug reactions (ADRs) on antibiotic therapy to superiors instead of filling out ADR forms. Antibiotics were kept in inpatient bedside cabinets with no thermometers to monitor the storage temperature conditions.
Research Limitations: The study was done in one Directorate in the hospital and thus cannot be generalized to reflect the situation in all teaching hospitals in Ghana.
Practical implication: The evidence obtained highlighted the need for pragmatic antimicrobial stewardship (AMS) at the directorate to help optimize the management of childhood infections and minimize the emergence and spread of antibiotic resistance.
Originality/Value. This was an original project designed to generate evidence to inform interventions to promote the responsible use of antimicrobials in children.
36
Van, Tuan Mai, Nhu Hiep Pham, Thi Lan Huong Hoang, Nhat Tan Dang, Thi Ngoc Anh Pham, Thanh Huy Nguyen, Quoc Tuan Cao, et al. "First-Time Use of Clinical Pharmacists to Improve Appropriate Antibiotic Prescribing in a Medical ICU in Viet Nam." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s236. http://dx.doi.org/10.1017/ice.2020.790.
Full textAbstract:
Background: Antibiotic overuse has led to increasing rates of antibiotic resistant infections and unnecessary antibiotic costs. Clinical pharmacists can play a key role in optimizing appropriate use of antimicrobials and reducing antimicrobial resistance. However, the role of clinical pharmacists in antimicrobial stewardship is new and not well established in Viet Nam. Objective: We evaluated the use of clinical pharmacists for improved antimicrobial prescribing. Methods: We assembled an antibiotic stewardship program (ASP) team consisting of a clinical pharmacist and a specialist in infection prevention and control in a 60-bed medical intensive care unit (MICU) at Hue Central Hospital in central Viet Nam. During January–September 2018, the ASP team collected baseline antibiotic prescribing days of therapy (DOT) for all antibiotics administered in the MICU. Then, from October 2018 through June 2019, the ASP team reviewed daily positive clinical bacterial cultures and susceptibility results for all patients present in the MICU. They reviewed medical charts, including antimicrobial prescriptions, during week days and only if patient was still in the ICU at the time of ASP rounds. The team recommended changes to antibiotic therapy verbally to physicians and left the decision to change antibiotic therapy to their discretion. The ASP team documented whether their recommendations were accepted or rejected. Statistical significance was determined using the Student t test. Results: The ASP team reviewed 160 medical charts and made 169 ASP recommendations: 122 (72%) to continue current treatment; 24 (14%) to monitor drug levels or obtain diagnostic tests; 10 (6%) to discontinue therapy; 6 (4%) to de-escalate therapy; 5 (3%) to adjust doses; and 2 (1%) to broaden therapy. Only 8 of the recommended changes (5%) were declined by the clinicians. The average monthly DOT for all types of antibiotics declined significantly from 2,213 to 1,681 (24% decrease; P = .04). Reductions in DOT for the most common broad-spectrum antibiotics included colistin from 303 to 276 (P = .75); imipenem-cilastatin 434 to 248 (P = .06); doripenem 150 to 144 (P = .85). Piperacillin-tazobactam increased from 122 to 142 (P = 0.75). Conclusions: We demonstrated that daily review of cultures and antibiotic use decreased overall antibiotic prescribing. Given that few recommendations included discontinuation of therapy, ASP rounds likely raised awareness for clinicians to optimize antibiotic use.Funding: NoneDisclosures: None
37
Davis, Sondra, Collin Verheyden, Mandelin Cooper, and Devak Desai. "Navigating the New Antimicrobial Stewardship Regulations." Hospital Pharmacy 52, no. 8 (July 26, 2017): 527–31. http://dx.doi.org/10.1177/0018578717721541.
Full textAbstract:
Purpose: Many health care facilities are navigating their way through the new antimicrobial stewardship standards and guidelines. The purpose of this article is to provide information for health care facilities to improve patient care. Summary: New regulations and guidelines surrounding antimicrobial stewardship have prompted facilities to review their process related to antimicrobial stewardship. In setting up a program, there are many factors to consider including involving key personnel, obtaining leadership support, identifying an infectious disease physician to chair or cochair the committee, and meeting agenda, metrics, and educational needs. Conclusion: Antimicrobial stewardship plays a vital role in both our hospital and community setting. Pharmacists are uniquely positioned to improve optimal patient care through rounding, review of patients’ chart, and contribute to the improvement of antimicrobial stewardship by working with a multidisciplinary team. These efforts may improve the utilization of antimicrobial agents.
38
Hsieh, Jenny, Hatim Sati, Pilar Ramon-Pardo, Nienke Bruinsma, Marcelo F. Galas, Jean Marie Rwangabwoba, Zoila Irene. Fletcher Payton, et al. "2034. Standardized Point Prevalence Survey on Antibiotic Use to Inform Antimicrobial Stewardship Strategies in the Caribbean." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S683—S684. http://dx.doi.org/10.1093/ofid/ofz360.1714.
Full textAbstract:
Abstract Background Inappropriate use of antimicrobials is one of the core contributors to antimicrobial resistance. While hospitals create high selection pressures on bacteria due to the high quantity and broader spectrum of antibiotics used, information on antimicrobial use at the patient level in the Caribbean is sparse. In response, PAHO implemented a standardized WHO methodology to engage national leaderships, build local capacity, and facilitate the use of data to inform antimicrobial stewardship programs (ASP) in the Caribbean. Methods Point prevalence surveys (PPS) were performed in four acute care hospitals in Barbados, Guyana and Saint Lucia between June and July 2018. Medical records of all inpatients were reviewed to collect information on antibiotic use, indications and use of laboratory services (Figure 1). A hospital questionnaire was used to assess hospital infrastructure, policy and practices, and monitoring and feedback systems (Figure 2). Training on PPS methods and electronic data collection tool in REDCap™ were provided to build local capacity and identify potential ASP leaderships. A standardized data validation, analysis and reporting system was built in R to streamline the process. Results and recommendations were disseminated to national authorities and stakeholders to support hospital and national decision-making and training for healthcare providers (Figure 3). Results A total of 60 physicians, nurses, pharmacists, laboratory technicians, and infection control specialists were trained and participated in the PPS. The survey collected records of 816 patients in which 442 (54%) were females and 374 (46%) were males. In total, 356 (44%) patients received 551 antibiotics. Overall, 300 (75%) of 398 indications for antibiotic use were treatment and 72 (18%) were prophylaxis. A higher use of parenteral antibiotics (79%) was observed compared with oral antibiotics (21%). Antibiotic prescribing patterns differed across hospitals. The most commonly used antibiotics were metronidazole (12%) and amoxicillin/clavulanate (11%). Conclusion The PPS method provided a feasible and effective way to collect baseline data and identify target areas for interventions. Engaging national leaderships and building local capacity offered a sustainable way in optimizing antimicrobial use in resource-limited settings. Disclosures All authors: No reported disclosures.
39
Setiawan, Eko, Menino O. Cotta, Mohd Hafiz Abdul-Aziz, Hernycane Sosilya, Doddy Widjanarko, Dian K. Wardhani, and Jason A. Roberts. "Indonesian healthcare providers’ perceptions and attitude on antimicrobial resistance, prescription and stewardship programs." Future Microbiology 17, no. 5 (March 2022): 363–75. http://dx.doi.org/10.2217/fmb-2021-0193.
Full textAbstract:
Background: A successful antimicrobial stewardship program (ASP) is sustained through improving antimicrobial prescribing by changing prescribing behavior. This requires a better understanding of hospital stakeholders’ views regarding antimicrobial resistance (AMR), antimicrobial use and participation in ASP activities. Objectives: Identify perceptions and attitudes among physicians and pharmacists in a public hospital toward AMR, prescription and ASP. Methods: A questionnaire consisting of 45 items was distributed to physicians and pharmacists in a 320-bed public hospital. All responses were formatted into the Likert scale. Results: A total of 78 respondents (73% response rate) completed the questionnaire. The majority of the respondents perceived AMR within hospital as less of a severe problem, and factors outside hospital were considered to be greater contributors to AMR. In addition, interprofessional conflict was identified as a serious concern in relation to implementing ASP. Conclusion: This finding indicates the need to address existing perceptions and attitudes toward ASP activities that may hamper its successful implementation in Indonesia.
40
Wong, Cynthia, Linda R. Taggart, and Elizabeth Leung. "1057. The Impact of Temporary Suspensions of an Antimicrobial Stewardship Audit and Feedback Program on Antimicrobial Utilization of General Internal Medicine Inpatients." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S373—S374. http://dx.doi.org/10.1093/ofid/ofz360.921.
Full textAbstract:
Abstract Background A goal of Antimicrobial Stewardship Programs (ASP) is to optimize antimicrobial use; many using audit and feedback (AAF). Although AAF decreases unnecessary target antimicrobial use, it is resource-intensive. As a result, temporary suspensions in AAF activity may occur from human resource limitations or other factors. We describe the impact of these temporary suspensions and intensity of care on antimicrobial utilization trends. Methods This retrospective study describes the initiation and temporary suspensions of AAF in the General Internal Medicine (GIM) unit at an urban teaching hospital. Data were collected over 65 months. During active-AAF, a dedicated ID trained clinical pharmacist and ID physician-reviewed antimicrobial use for all GIM patients and provided patient-specific advice to physicians. Antimicrobial use was measured by Defined Daily Doses (DDD) normalized per 1,000 patient-days. To assess the impact of temporary suspensions, data were compared in two ways: 1. All nonactive-AAF time-frames were compared with active AAF 2. Pre-ASP was compared with Post-ASP Initiation which includes suspension periods. To determine whether differences in trends were seen based on acuity level of the patients (identified at admission as benefiting from frequent monitoring), analyses were repeated after stratification of patients admitted to the Step-Up unit (GIM-SU) and the regular ward (GIM-W). Results Comparing nonactive AAF vs. active-AAF, significant changes (P < 0.05) in mean normalized DDD were observed for total antimicrobials (-19%), antipseudomonals (-21%) fluoroquinolones (−41%) and first-generation β lactams (−30%). Pre ASP vs. Post ASP comparisons showed similar but less pronounced trends. Following stratification to GIM-SU and GIM-W, greater variation in significant changes to targeted antimicrobials between comparisons was observed. Different significant antimicrobial changes were seen in SU vs. W. Conclusion Our results show that the temporary suspension of ASP AAF impacts antimicrobial utilization trends. Greater sustained decreases in targeted antimicrobials utilization were associated with active AAF. Stratification by patient acuity lead to increased variation in the impact on target antimicrobials and increased the impact of suspension. Disclosures All authors: No reported disclosures.
41
Guarch-Ibáñez, Borja, Aurora Fernández-Polo, Sergi Hernández, Eneritz Velasco-Arnaiz, Montse Giménez, Pere Sala-Castellvi, Valentí Pineda, and Susana Melendo. "Assessment of the Plans to Optimize Antimicrobial Use in the Pediatric Population in Catalan Hospitals: The VINCat Pediatric PROA SHARP Survey." Antibiotics 12, no. 2 (January 26, 2023): 250. http://dx.doi.org/10.3390/antibiotics12020250.
Full textAbstract:
In Spain, many programs have been introduced in recent years to optimize antimicrobial stewardship in pediatric care (known as pediatric PROA). However, information on the current situation of these programs is scarce. The present study assesses current antimicrobial use in pediatric care in the hospitals of Catalonia affiliated with the VINCat pediatric PROA group. Between December 2020 and January 2021, an electronic survey related to the design and use of PROA was administered to members of PROA teams in our hospital network. The survey was conducted at 26 hospitals. Twelve percent of the hospitals had pediatric PROA in operation, 42% were included in adult PROA, and 46% carried out pediatric PROA activities but not as part of an established program. At 81%, the pediatric PROA team included a pediatrician, in 58% a pharmacist, and in 54% a microbiologist. The main activities were monitoring the use of antimicrobials and bacterial resistance. Twenty-seven percent measured indicators regularly. The VINCat Pediatric PROA group’s hospitals have implemented measures for optimizing antimicrobial stewardship, but few have a pediatric PROA program in place. Specific measures and indicators must be defined, and the resources available should be increased. The development of pediatric PROA should be monitored in the coming years.
42
Bariola, J. Ryan, and Tina Khadem. "1067. Variation of Antimicrobial Stewardship Programs’ Membership and Organization Within a Single Health System." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S378. http://dx.doi.org/10.1093/ofid/ofz360.931.
Full textAbstract:
Abstract Background Antimicrobial stewardship programs (ASPs) vary in terms of members and administrative (admin) structure. Joint Commission (TJC) has member requirements, but little is known about adherence or how ASP’s fit into hospitals’ admin structures. We reviewed the makeup and organization of ASP’s within a single healthcare system. Methods Survey of pharmacy directors or ASP pharmacists at 14 system hospitals in January 2019. Results All hospitals responded. All are TJC accredited. Thirteen (92%) had a local stewardship committee. Of these 13, 6 (42%) met quarterly, 4 (30%) monthly, and 3 (21%) every other month. 9 (69%) were a subcommittee of Pharmacy and Therapeutics, and 1 (11%) was a separate committee. 3 (23%) had no clearly defined reporting structure. Figure 1 shows ASP committee compositions. 9 (69%) had all TJC required members, if ID physician is considered a required member. All had pharmacy representation but only 4 (30%) had a pharmacist with ID training. Most had representation from ID physicians (10), Infection Prevention (12), other practitioners (11), and microbiology lab (9). Less than half had hospital admin members, and only 2 had nursing members. None had Information Technology (IT) representation. 12 (92%) created minutes, but only 4 (30%) forwarded minutes for review by hospital admin. Tables 1–3 describe relationships between hospitals based on bed size, if they submitted minutes for review, and if they had both an ID pharmacist and ID physician as members. No hospital indicated citations during a TJC visit about membership or organization. Conclusion ASPs within even a single health system vary as to membership and organizational structure. Some did not have all TJC required members. With few having admin representation or submitting minutes for admin review, it raises the concern of ASPs being ignored and possible noncompliance with TJC requirements regarding leadership support. ASP’s should actively work with hospital admins to ensure they have all needed representation and develop reporting mechanisms that keep hospital admins aware of their successes and needs. Lack of involvement from pharmacists with ID expertise, nursing, and IT are issues also. Larger evaluations are needed to determine whether membership and administrative structure can impact antimicrobial usage. Disclosures All authors: No reported disclosures.
43
Olson, J. A., E. Stenehjem, W. R. Buckel, E. A. Thorell, S. Howe, X. Wu, P. S. Jones, J. F. Lloyd, and R. S. Evans. "Use of Computer Decision Support in an Antimicrobial Stewardship Program (ASP)." Applied Clinical Informatics 06, no. 01 (2015): 120–35. http://dx.doi.org/10.4338/aci-2014-11-ra-0102.
Full textAbstract:
SummaryObjective: Document information needs, gaps within the current electronic applications and reports, and workflow interruptions requiring manual information searches that decreased the ability of our antimicrobial stewardship program (ASP) at Intermountain Healthcare (IH) to prospectively audit and provide feedback to clinicians to improve antimicrobial use.Methods: A framework was used to provide access to patient information contained in the electronic medical record, the enterprise-wide data warehouse, the data-driven alert file and the enterprise-wide encounter file to generate alerts and reports via pagers, emails and through the Centers for Diseases and Control’s National Healthcare Surveillance Network.Results: Four new applications were developed and used by ASPs at Intermountain Medical Center (IMC) and Primary Children’s Hospital (PCH) based on the design and input from the pharmacists and infectious diseases physicians and the new Center for Diseases Control and Prevention/ National Healthcare Safety Network (NHSN) antibiotic utilization specifications. Data from IMC and PCH now show a general decrease in the use of drugs initially targeted by the ASP at both facilities.Conclusions: To be effective, ASPs need an enormous amount of “timely” information. Members of the ASP at IH report these new applications help them improve antibiotic use by allowing efficient, timely review and effective prioritization of patients receiving antimicrobials in order to optimize patient care.Citation: Evans RS, Olson JA, Stenehjem E, Buckel WR, Thorell EA, Howe S, Wu X, Jones PS, Lloyd JF. Use of computer decision support in an antimicrobial stewardship program (ASP). Appl Clin Inf 2015; 6: 120–135http://dx.doi.org/10.4338/ACI-2014-11-RA-0102
44
Eatemadi, Arash, Sirous Golchinheydari, Ahmed Al Za'abi, Samar Al Bartamani, Abdullah Al Roshdi, Adel Al Baloushi, and Amna AL Baloushi. "ANTIMICROBIAL STEWARDSHIP PROGRAM IN THE EMERGENCY DEPARTMENT: DREAMLAND OF CLINICAL PHARMACISTS?" Journal of Biomedical and Pharmaceutical Research 10, no. 1 (February 9, 2021): 26–28. http://dx.doi.org/10.32553/jbpr.v10i1.823.
Full textAbstract:
Antibiotic prescription and antimicrobial resistance are parallel to each other. Misuse of antibiotics can increase health system costs and more importantly, morbidity and mortality, due to the emerging multi-drug resistant pathogens. Implementation of antibiotic stewardship programs in the hospital wards and intensive care units are a well-known action, however, there is an attention deficit regarding this activity in emergency department, the portal of admission to the wards. Therefore, making a specific plan with leadership of clinical pharmacists is highly desirable.
Key words: Antimicrobial resistance, Emergency department, Clinical pharmacists
45
Smith, Lindsay, and John W. Ahern. "1008. The Reduction of Fluoroquinolone Prescribing in Rural Vermont Hospitals." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S354—S355. http://dx.doi.org/10.1093/ofid/ofz360.872.
Full textAbstract:
Abstract Background In 2017 The Joint Commission required all hospitals irrespective of size to implement antimicrobial stewardship programs (ASPs) using the CDC core elements (CE) for antimicrobial stewardship (AS). Critical access and rural community hospitals have struggled with developing effective ASPs. Many ASPs seek to reduce fluoroquinolone (FQ) prescribing due to its high risk for drug-drug interactions, risk of Clostridioides difficile infection, and numerous side effects, including five black box warnings from the FDA. Methods We contracted with the Vermont Department of Health to help rural VT hospitals develop ASPs that are compliant with the CDC CE for AS. Six of Vermont’s 13 hospitals were recruited between June – December 2017 (Table 1). Each hospital obtained antibiotic usage (AU) data in grams (g)/1000 (1k) patient-days (PD) from their electronic medical record (EMR), starting from January 2017. All identified FQ as frequently prescribed antimicrobials. Each hospital had unique interventions to decrease FQ prescribing (Table 1), including orderset changes and pharmacist intervention. Monthly combined FQ (ciprofloxacin + levofloxacin) administration data were collected in g/1K PD. AU data from each hospital were summed and expressed as total FQ g/1000 patient-days. The FQ prescribing trend was analyzed by linear regression. Results Prior to implementing ASP, there was a combined FQ rate of 69 g/1K PD. After 20 months of ASP interventions, combined FQ prescribing decreased to 26 g/1K PD (Figure 1, R= 0.9797, P < 0.001). This trend is also significant for each individual FQ: ciprofloxacin (R=0.8364, P < 0.05) and levofloxacin (R= 0.9801, P < 0.01). Conclusion Rural and critical access hospitals can have successful antimicrobial stewardship programs. We have shown that rural hospitals in Vermont (1) can extract AU data from their EMR, (2) develop interventions to decrease high use antimicrobial agents, and (3) be successful in decreasing FQ prescribing in less than 2 years. Disclosures All authors: No reported disclosures.
46
Spigelmyer, Amy, Catessa Howard, Ilya Rybakov, Sheena Burwell, and Douglas Slain. "96. Impact of Hospital-Based Pharmacist Discharge Prescription Review on the Appropriateness of Antibiotic Therapy." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S163. http://dx.doi.org/10.1093/ofid/ofab466.298.
Full textAbstract:
Abstract Background Inappropriate antibiotic prescribing upon hospital discharge poses an increased risk of excess costs, adverse drug reactions, readmission, and resistance. Despite high rates of antibiotic prescription errors upon discharge, there is no widely accepted antimicrobial stewardship initiative to prevent such errors. This study evaluated the impact of hospital-based clinical pharmacist discharge prescription review on the appropriateness of antibiotic prescriptions. Methods This was a retrospective assessment of patients with discharge antibiotic prescriptions for treatment of pneumonia, urinary tract infections, Clostridioides difficile infections, acute skin and skin structure infections (ABSSSI), or Gram-negative bacteremia between January 2019 and July 2020. The two cohorts that were studied were patients on Hospitalist services versus patients on Medicine services, in which only the Medicine services had rounding pharmacists who perform discharge prescription reviews. Outcomes included demographics, appropriateness of therapy, 30-day readmission rates, and error types in discharge prescriptions. Appropriateness of therapy was validated by evidence-based guidelines and three Infectious Diseases-trained pharmacists. Results Our study included 300 patients, 150 per cohort. Baseline characteristics were similar between groups, with the exception of increased age (p=0.025) and fewer cases of ABSSSI (p=0.001) in the Hospitalist cohort. A statistically significant higher rate of inappropriateness was seen in the Hospitalist group versus Medicine (pharmacist) group, [69/150 (46% versus 25/150 (17%, respectively (p< 0.00001)]. The difference in appropriateness was mainly driven by pneumonia and UTI prescriptions. Thirty day readmission rates were 17% (26/150) for the Hospitalist cohort versus 11% (16/150) in the Medicine (pharmacist) cohort (p=0.134). The most common prescription error was the duration of therapy. Conclusion Appropriateness of antibiotic discharge prescriptions significantly improved in the setting of pharmacist discharge prescription review. This initiative highlights the important role of clinical pharmacists in the setting of outpatient antimicrobial stewardship. Disclosures All Authors: No reported disclosures
47
Stang, Christopher R. T., Preeti Jaggi, Jessica Tansmore, Katelyn Parson, Kathryn E. Nuss, Matthew Sapko, R. Zachary Thompson, et al. "Implementation of a Pharmacist-Led Antimicrobial Time-Out for Medical-Surgery Services in an Academic Pediatric Hospital." Journal of Pediatric Pharmacology and Therapeutics 26, no. 3 (March 1, 2021): 284–90. http://dx.doi.org/10.5863/1551-6776-26.3.284.
Full textAbstract:
OBJECTIVE This report describes a quality improvement initiative to implement a pharmacist-led antimicrobial time-out (ATO) in a large, freestanding pediatric hospital. Our goal was to reach 90% ATO completion and documentation for eligible patients hospitalized on general pediatric medicine or surgery services. METHODS A multidisciplinary quality improvement team developed an ATO process and electronic documentation tool. Clinical pharmacists were responsible to initiate and document an ATO for pediatric medicine or surgery patients on or before the fifth calendar day of therapy. The quality improvement team educated pharmacists and physicians and provided ATO audit and feedback to the pharmacists. We used statistical process control methods to track monthly rates of ATO completion retrospectively from October 2017 through March 2018 and prospectively from April 2018 through April 2019. Additionally, we retrospectively evaluated the completion of 6 data elements in the ATO note over the final 12-month period of the study. RESULTS Among 647 eligible antimicrobial courses over the 19-month study period, the mean monthly documentation rate increased from 54.6% to 83.5% (p < 0.001). The mean ATO documentation rate increased from 32.8% to 74.2% (p < 0.001) for the pediatric medicine service and from 65.0% to 88.1% for the pediatric surgery service (p = 0.006). Among 302 notes assessed for completeness, 35.8% had all the required data fields completed. A tentative antimicrobial stop date was the data element completed least often (49.3%). CONCLUSIONS We implemented a pharmacist-led ATO, highlighting the role pharmacists play in antimicrobial stewardship. Additional efforts are needed to further increase ATO completion rates and to define treatment duration.
48
Nampoothiri, Vrinda, Akkulath Sangita Sudhir, Mariam Varsha Joseph, Zubair Mohamed, Vidya Menon, Esmita Charani, and Sanjeev Singh. "Mapping the Implementation of a Clinical Pharmacist-Driven Antimicrobial Stewardship Programme at a Tertiary Care Centre in South India." Antibiotics 10, no. 2 (February 23, 2021): 220. http://dx.doi.org/10.3390/antibiotics10020220.
Full textAbstract:
In many parts of the world, including in India, pharmacist roles in antimicrobial stewardship (AMS) programmes remain unexplored. We describe the evolution and effect of the role of adding clinical pharmacists to a multidisciplinary AMS at a tertiary care teaching hospital in Kerala, India. Through effective leadership, multidisciplinary AMS (February 2016) and antitubercular therapy (ATT) stewardship programmes (June 2017) were established. Clinical pharmacists were introduced as core members of the programmes, responsible for the operational delivery of key stewardship interventions. Pharmacy-led audit and feedback monitored the appropriateness of antimicrobial prescriptions and compliance to AMS/ATT recommendations. Between February 2016 and January 2017, 56% (742/1326) of antimicrobial prescriptions were appropriate, and 54% (318/584) of recommendations showed compliance. By the third year of the AMS, appropriateness increased to 80% (1752/2190), and compliance to the AMS recommendations to 70% (227/325). The appropriateness of ATT prescriptions increased from a baseline of 61% (95/157) in the first year, to 72% (62/86, June 2018–February 2019). The compliance to ATT recommendations increased from 42% (25/60) to 58% (14/24). Such a model can be effective in implementing sustainable change in low- and middle-income countries (LMICs) such as India, where the shortage of infectious disease physicians is a major impediment to the implementation and sustainability of AMS programmes.
49
Simon, Samuel, Rosanna Li, Yu Shia Lin, Suri Mayer, Edward Chapnick, and Monica Ghitan. "157. A Multidisciplinary Approach to Carbapenem Stewardship at a Large Community Hospital in Brooklyn, New York." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S88. http://dx.doi.org/10.1093/ofid/ofaa439.202.
Full textAbstract:
Abstract Background Carbapenem-resistant gram-negative organisms are a continuously mounting threat, underscoring the need for effective antimicrobial stewardship interventions to improve the use of carbapenems. We sought to implement several multidisciplinary antimicrobial stewardship interventions beginning in January 2019 in an effort to reduce unnecessary meropenem use and the incidence of carbapenem-resistant gram-negatives. Methods Prospective audit and feedback was utilized daily in combination with weekly stewardship rounds between an Infectious Diseases pharmacist and physician in the Intensive Care Units. A second Infectious Diseases physician attended weekly interdisciplinary rounds on meropenem high-use units. Meropenem Days of Therapy (DOT) per 1,000 patient days and the incidence of meropenem resistant Pseudomonas aeruginosa and Klebsiella pneumoniae were compared by the chi-square test of proportions. Results Between 2018 and 2019 the institution’s meropenem DOT per 1,000 patient days decreased 33%, from 57 to 38 days per 1,000 patient days (difference, 19 days per 1,000 patient days; p< 0.001). In the hospital antibiogram, the meropenem susceptibility of Pseudomonas aeruginosa over the same time period increased from 71% to 77% of isolates (difference, 6%; p = 0.009). A non-significant decrease in the susceptibility of meropenem to Klebsiella pneumoniae was also observed from 92 to 90% (difference, 2%: p = 0.1658). Conclusion These data support the need for antimicrobial stewardship efforts targeting broad-spectrum antimicrobials such as meropenem. In the setting of a sustained decrease in meropenem use over 12 months, we observed a significant improvement in the percent susceptibility rate of Pseudomonas aeruginosa to meropenem for the first time in five years. Disclosures All Authors: No reported disclosures
50
Torney, Nicholas P., and Michael D. Tiberg. "Description of a pharmacist-managed/administered penicillin allergy skin testing service at a community hospital." American Journal of Health-System Pharmacy 78, no. 12 (February 21, 2021): 1066–73. http://dx.doi.org/10.1093/ajhp/zxab068.
Full textAbstract:
Abstract Purpose To describe how a pharmacist-managed and pharmacist-administered penicillin allergy skin testing (PAST) service was incorporated into an antimicrobial stewardship program at a community hospital. Methods A pharmacist-managed/administered PAST service was initiated in October 2015. Patients 18 years of age or older were considered for PAST if they had a reported history of a type I or unknown type of allergic reaction to penicillin that occurred more than 5 years previously. Patients with a vague allergy history were considered for PAST if the provider was uncomfortable prescribing a preferred β-lactam out of concern for penicillin allergy. Patients were excluded if they were pregnant, had a history of a non–type I allergic reaction, or recently received antihistamines. The primary outcome was the percentage of patients who underwent PAST and were subsequently transitioned to a preferred β-lactam. Results PAST was initiated in 90 patients from October 2015 to December 2019. Eighty-five out of 90 patients (94%) completed PAST. Seventy-six out of 90 patients (84.4%) who underwent PAST were transitioned to a preferred β-lactam. The most commonly administered antibiotics prior to PAST were vancomycin, cefepime, and metronidazole. The most commonly used antibiotics after PAST were penicillin, piperacillin/tazobactam, and ampicillin/sulbactam. Among the 90 patients who underwent PAST, alternative antibiotics were avoided for a total of 1,568 days, with a median of 11 days (interquartile range, 6-18 days) avoided per patient. Conclusion Incorporating a pharmacist-managed/administered PAST service into a community hospital’s antimicrobial stewardship program can improve the utilization of preferred antimicrobial therapy and help avoid use of more toxic, costly antimicrobials.