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Engel-Dettmers EM, Al Naiemi N, Dijkema HE, Braakman-Jansen AL, van Gemert-Pijnen LJ, Sinha B. Positive effects of audit and feedback on antimicrobial use in hospitalized patients limited to audited patients. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e46. [PMID: 38628373 PMCID: PMC11019582 DOI: 10.1017/ash.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
Objective Audit and feedback is an antimicrobial stewardship (AMS) strategy, with the potential to also optimize antimicrobial use in non-audited patients. This study aimed to determine whether audit and feedback reduce antimicrobial use in both audited and non-audited patients. Design Before-after trial with a 1-year intervention period and 2.5-year historical cohort. Setting 750-bed community hospital in the Netherlands. Patients All patients admitted to the urology wards during the 3.5-year study period were observed. Patients were classified as using antimicrobials if any antimicrobial was used for therapeutic reasons. Patients using antimicrobials prophylactically were excluded from measurements. Intervention The AMS team provided audit and feedback on antimicrobial use for patients using antimicrobials for 2 days. Retrospectively, antimicrobial use and length of stay (LOS) were compared with the historical cohort. Results Audits modified antimicrobial treatment in 52.8% of the cases. De-escalating, stopping, and switching from intravenous to oral treatment accounted for 72% of these modifications. Compared to patients from the cohort, who also used antimicrobials for 2 days, antimicrobial use decreased from 14.21 DDD/patient (95% CI, 13.08-15.34) to 11.45 DDD/patient (95% CI, 8.26-14.64; P = .047) for audited patients. Furthermore, mean LOS decreased from 7.42 days (95% CI, 6.79-8.06) to 6.13 days (95% CI, 5.38-6.89; P = .031). However, looking at all patients admitted to the urology wards, the percentage of patients using antimicrobials and total antimicrobial use remained unchanged. Conclusions Audit and feedback reduce antimicrobial use and LOS, but only for audited patients. Positive effects are not automatically transferred to patients for whom no audits have been performed.
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Affiliation(s)
- Elske M. Engel-Dettmers
- Faculty of Behavioral, Management and Social Sciences, Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
- Department of Clinical Pharmacy, ZGT, Almelo and Hengelo, The Netherlands
| | - Nashwan Al Naiemi
- Department of Medical Microbiology, Labmicta, Hengelo, The Netherlands
| | - Hero E. Dijkema
- Department of Urology, ZGT, Almelo and Hengelo, The Netherlands
| | - Annemarie L.M.A. Braakman-Jansen
- Faculty of Behavioral, Management and Social Sciences, Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Lisette J.E.W.C. van Gemert-Pijnen
- Faculty of Behavioral, Management and Social Sciences, Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
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Hammond KM, Kabbani D, Doucette KE, Smith SW, Lau C, Bains S, Fong K, Stewart J, Chen JZ. How does the antimicrobial stewardship provider role affect prospective audit and feedback acceptance for restricted antibiotics in a Canadian tertiary-care center? Infect Control Hosp Epidemiol 2024; 45:234-236. [PMID: 37592906 PMCID: PMC10877530 DOI: 10.1017/ice.2023.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 08/19/2023]
Abstract
Of 731 restricted antimicrobial prescriptions subject to antimicrobial stewardship program (ASP) prospective audit and feedback (PAF) over a 3-year period, 598 PAF recommendations (82%) were fully accepted. Physician auditors had an increased odds of PAF recommendation acceptance, reinforcing the complementary role of the ASP physician in the multidisciplinary ASP team.
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Affiliation(s)
- Keely M. Hammond
- Core Internal Medicine Program, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dima Kabbani
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karen E. Doucette
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie W. Smith
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Cecilia Lau
- Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Serena Bains
- Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Karen Fong
- Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jackson Stewart
- Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Justin Z. Chen
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Neuner EA, Atkinson A, Ilges D, Krekel T, Ritchie DJ, Bewley AF, Durkin MJ, Hsueh K, Sayood S. Mixed methods evaluation of handshake antimicrobial stewardship on adult inpatient medicine floors. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e210. [PMID: 38156212 PMCID: PMC10753471 DOI: 10.1017/ash.2023.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023]
Abstract
Objective To evaluate the effects of handshake antimicrobial stewardship on medicine floors at a large tertiary care hospital. Design Retrospective observational study. Setting 1,278-bed academic hospital. Patients Adults admitted to non-ICU medicine services. Interventions A handshake stewardship team consisting of an infectious diseases (ID) physician and pharmacist reviewed charts of patients receiving antimicrobials on medicine floors without a formal ID consult. Recommendations were communicated in-person to providers and acceptance rates were examined with descriptive statistics. Additional data regarding program perception among providers were obtained via surveys. Antibiotic usage trends were extracted from National Healthcare Safety Network Antimicrobial Use option data and evaluated using an interrupted time-series analysis pre- and post-intervention. Results The overall acceptance rate of interventions was 80%, the majority being recommendations either to discontinue (37%) or de-escalate therapy (28%). Medical residents and hospitalists rated the intervention favorably with 90% reporting recommendations were helpful all or most of the time. There was a statistically significant decrease in vancomycin (78 vs 70 DOT/1,000 d present (DP), p = 0.002) and meropenem (24 vs 17 DOT/1,000 DP, p = 0.007) usage and a statistically significant increase in amoxicillin-clavulanate usage (11 vs 15 DOT/1,000 DP, p < 0.001). Overall antibiotic usage remained unchanged by the intervention, though pre-intervention there was a nonsignificant overall increasing trend while post-intervention there was a nonsignificant decreasing trend in overall usage. There was no change in in-hospital mortality. Conclusion The addition of handshake stewardship with adult medicine services was favorably viewed by participants and led to shifts in antibiotic usage.
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Affiliation(s)
| | - Andrew Atkinson
- Department of Internal Medicine, Division of Infectious Diseases, Washington University, School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dan Ilges
- Department of Pharmacy, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Tamara Krekel
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - David J. Ritchie
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Alice F. Bewley
- Department of Internal Medicine, Division of Infectious Diseases, Washington University, School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michael J. Durkin
- Department of Internal Medicine, Division of Infectious Diseases, Washington University, School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kevin Hsueh
- Department of Internal Medicine, Division of Infectious Diseases, Washington University, School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sena Sayood
- Department of Internal Medicine, Division of Infectious Diseases, Washington University, School of Medicine in St. Louis, St. Louis, MO, USA
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Performance of infectious diseases specialists, hospitalists, and other internal medicine physicians in antimicrobial case-based scenarios: Potential impact of antimicrobial stewardship programs at 16 Veterans' Affairs medical centers. Infect Control Hosp Epidemiol 2023; 44:400-405. [PMID: 35506398 PMCID: PMC10015262 DOI: 10.1017/ice.2022.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As part of a project to implement antimicrobial dashboards at select facilities, we assessed physician attitudes and knowledge regarding antibiotic prescribing. DESIGN An online survey explored attitudes toward antimicrobial use and assessed respondents' management of four clinical scenarios: cellulitis, community-acquired pneumonia, non-catheter-associated asymptomatic bacteriuria, and catheter-associated asymptomatic bacteriuria. SETTING This study was conducted across 16 Veterans' Affairs (VA) medical centers in 2017. PARTICIPANTS Physicians working in inpatient settings specializing in infectious diseases (ID), hospital medicine, and non-ID/hospitalist internal medicine. METHODS Scenario responses were scored by assigning +1 for answers most consistent with guidelines, 0 for less guideline-concordant but acceptable answers and -1 for guideline-discordant answers. Scores were normalized to 100% guideline concordant to 100% guideline discordant across all questions within a scenario, and mean scores were calculated across respondents by specialty. Differences in mean score per scenario were tested using analysis of variance (ANOVA). RESULTS Overall, 139 physicians completed the survey (19 ID physicians, 62 hospitalists, and 58 other internists). Attitudes were similar across the 3 groups. We detected a significant difference in cellulitis scenario scores (concordance: ID physicians, 76%; hospitalists, 58%; other internists, 52%; P = .0087). Scores were numerically but not significantly different across groups for community-acquired pneumonia (concordance: ID physicians, 75%; hospitalists, 60%; other internists, 56%; P = .0914), for non-catheter-associated asymptomatic bacteriuria (concordance: ID physicians, 65%; hospitalists, 55%; other internists, 40%; P = .322), and for catheter-associated asymptomatic bacteriuria (concordance: ID physicians, 27% concordant; hospitalists, 8% discordant; other internists 13% discordant; P = .12). CONCLUSIONS Significant differences in performance regarding management of cellulitis and low overall performance regarding asymptomatic bacteriuria point to these conditions as being potentially high-yield targets for stewardship interventions.
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Novel expansion of a well-established antimicrobial stewardship program: Enhancing program efficiency and reach. Infect Control Hosp Epidemiol 2022:1-6. [DOI: 10.1017/ice.2022.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective:
To evaluate efficiency and impact of a novel antimicrobial stewardship program (ASP) prospective-audit-with-feedback (PAF) review process using the Cerner Multi-Patient Task List (MPTL).
Design:
Retrospective cohort study.
Setting:
A 367-bed free-standing, pediatric academic medical center.
Methods:
The ASP PAF review process expanded to monitor all systemic and inhaled antibiotics through use of the MPTL on July 23, 2020. Average number of daily ASP reviews, absolute number of monthly interventions, and time to conduct ASP reviews were compared between the preimplementation period and the postimplementation period following expansion. Antibiotic days of therapy (DOT) per 1,000 patient days for overall and select antibiotics were compared between periods. ASP intervention characteristics were assessed.
Results:
Average daily ASP reviews significantly increased following program expansion (9 vs 14 reviews; P < .0001), and the absolute number of ASP interventions each month also increased (34 vs 52 interventions; P ≤ .0001). Time to conduct daily ASP reviews increased in the postimplementation period (1.03 vs 1.32 hours). Overall antibiotic DOT per 1,000 patient days significantly decreased in the postimplementation period (457.9 vs 427.9; P < .0001) as well as utilization of select, narrow-spectrum antibiotics such as ampicillin and clindamycin. Intervention type and antibiotics were similar between periods. The ASP documented 128 “nonantibiotic interventions” in the postimplementation period, including culture and/or susceptibility testing (32.8%), immunizations (25.8%), and additional diagnostic testing (22.7%).
Conclusions:
Implementation of an ASP PAF review process using the MPTL allowed for efficient expansion of a pre-existing ASP and a decrease in overall antibiotic utilization. ASP documentation was enhanced to fully track the impact of the program.
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Chan AJ, Nisenbaum R, Downing M, Langford BJ. Evaluating the impact of mandatory indications on antibiotic utilization in a community hospital. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e121. [PMID: 36483345 PMCID: PMC9726569 DOI: 10.1017/ash.2022.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We evaluated the impact of introducing a mandatory indication field into electronic order entry for targeted antibiotics in adult inpatients. DESIGN Retrospective, before-and-after trial. SETTING A 400-bed community hospital. INTERVENTIONS All adult electronic intravenous (IV) and enteral orders for targeted antibiotics (moxifloxacin, ciprofloxacin, clindamycin, vancomycin, and metronidazole) had a mandatory indication field added. Control antibiotics (amoxicillin-clavulanate, ceftriaxone and piperacillin-tazobactam) were chosen to track shifts in antibiotic prescribing due to the introduction of mandatory indication field. METHODS Descriptive statistics were used to summarize the primary outcome, measured in Defined Daily Doses (DDD) per 1000 patient days (PD). Interrupted time-series (ITS) analysis was performed to compare levels and trends in antibiotic usage of targeted and control antibiotics during 24 months before and after the intervention. Additionally, a descriptive analysis of mandatory indication fields for targeted antibiotics in the postintervention period was conducted. RESULTS In total, 4,572 study antibiotic orders were evaluated after the intervention. Preset mandatory indications were selected for 30%-55% of orders. There was decreased usage of targeted antibiotics (mean, 92.02 vs 72.07 DDD/1000-PD) with increased usage of control antibiotics (mean, 102.73 vs 119.91 DDD/1000-PD). ITS analysis showed no statistically significant difference in overall antibiotic usage before and after the intervention for all targeted antibiotics. CONCLUSION This study showed moderate use of preset mandatory indications, suggesting that the preset list of indications can be optimized. There was no impact on overall antibiotic usage with the use of mandatory indications. More prospective research is needed to study the utility of this intervention in different contexts.
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Affiliation(s)
| | - Rosane Nisenbaum
- University of Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Ontario, Canada
- Applied Health Research Centre and MAP Centre for Urban Solutions, Ontario, Canada
| | - Mark Downing
- Unity Health Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Bradley J. Langford
- Public Health Ontario, Ontario, Canada
- Hotel Dieu Shaver Health and Rehabilitation Centre, Ontario, Canada
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Which pharmacists are performing antimicrobial stewardship: A national survey and a call for collaborative efforts. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2022; 2:e24. [PMID: 36310809 PMCID: PMC9614867 DOI: 10.1017/ash.2021.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022]
Abstract
Objectives: To determine how pharmacists with formal antimicrobial stewardship program (ASP) responsibilities prioritize their time and pharmacists without formal antimicrobial stewardship program responsibilities contribute to ASP activities. Design: A nationwide survey. Respondents: Members of the American College of Clinical Pharmacy who subscribe to the following practice and research network e-mail listservs: infectious diseases, adult medicine, cardiology, critical care, hematology–oncology, immunology and transplantation, and pediatrics. Methods: A survey was distributed via listservs. Respondents were asked about their personal and institutional demographics and ASP activities. Results: In total, 245 pharmacists responded: 135 pharmacists with formal antimicrobial stewardship program responsibilities; 110 pharmacists without formal antimicrobial stewardship program responsibilities. Although most respondents had completed a general pharmacy residency (85%), only 20% had completed an infectious diseases (ID) specialty residency. Among pharmacists with formal antimicrobial stewardship program responsibilities, one-third had no formal training or certification in ID or ASP. Pharmacists without formal antimicrobial stewardship program responsibilities spent ∼12.5% of their time per week on ASP activities, whereas pharmacists with formal antimicrobial stewardship program responsibilities spent 28% of their time performing non-ASP activities. Pharmacists with formal antimicrobial stewardship program responsibilities were more likely than pharmacists without formal antimicrobial stewardship program responsibilities to perform antibiotic guideline development (P < .001), antibiotic-related education (P = .002), and direct notification of rapid diagnostic results (P = .018). Pharmacists with formal antimicrobial stewardship program responsibilities without formal ID training or certification spent less time on ASP activities and were more likely to perform lower-level interventions. Conclusions: Many ASP activities are being performed by pharmacists without formal ID training. To ensure the future success of ASPs, pharmacists with formal antimicrobial stewardship program responsibilities should have adequate training to meet more advanced metrics, and more pharmacists without formal antimicrobial stewardship program responsibilities should be included in basic interventions.
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Stover KR, Chahine EB, Cluck D, Green S, Chastain DB, Childress D, Faulkner-Fennell C, Lusardi K, McGee EU, Turner M, Bookstaver PB, Bland CM. A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019. Open Forum Infect Dis 2020; 7:ofaa402. [PMID: 33134408 PMCID: PMC7585323 DOI: 10.1093/ofid/ofaa402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/26/2020] [Indexed: 12/27/2022] Open
Abstract
Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training and to identify potential intervention opportunities within one’s institution.
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Affiliation(s)
- Kayla R Stover
- Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Elias B Chahine
- Pharmacy Practice, Palm Beach Atlantic University Lloyd L. Gregory School of Pharmacy, West Palm Beach, Florida, USA
| | - David Cluck
- Pharmacy Practice, East Tennessee State University Bill Gatton College of Pharmacy, Johnson City, Tennessee, USA
| | - Sarah Green
- Novant Health, Winston-Salem, North Carolina, USA
| | | | | | - Carmen Faulkner-Fennell
- Prisma Health-Upstate, Greenville, South Carolina, USA.,USC School of Medicine-Greenville, Greenville, South Carolina, USA
| | - Katherine Lusardi
- Antimicrobial Stewardship, University of Arkansas Medical Center, Little Rock, Arkansas, USA
| | - Edoabasi U McGee
- Pharmacy Practice, Philadelphia College of Osteopathic Medicine School of Pharmacy, Suwanee, Georgia, USA
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