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Hamilton RA, Courtenay M, Frost KJ, Harrison R, Root H, Allison DG, Tonna AP, Ashiru-Oredope D, Aldeyab MA, Shemilt K, Martin SJ. Implementation of the national antimicrobial stewardship competencies for UK undergraduate healthcare professional education within undergraduate pharmacy programmes: a survey of UK schools of pharmacy. JAC Antimicrob Resist 2023; 5:dlad095. [PMID: 37560542 PMCID: PMC10409409 DOI: 10.1093/jacamr/dlad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Pharmacists play a key role in antimicrobial stewardship (AMS). Consensus-based national AMS competencies for undergraduate healthcare professionals in the UK reflect the increasing emphasis on competency-based healthcare professional education. However, the extent to which these are included within undergraduate pharmacy education programmes in the UK is unknown. OBJECTIVES To explore which of the AMS competencies are delivered, including when and at which level, within UK undergraduate MPharm programmes. METHODS A cross-sectional online questionnaire captured the level of study of the MPharm programme in which each competency was taught, the method of delivery and assessment of AMS education, and examples of student feedback. RESULTS Ten institutions completed the survey (33% response rate). No institution reported covering all 54 AMS competencies and 5 of these were taught at half or fewer of the institutions. Key gaps were identified around taking samples, communication, outpatient parenteral antimicrobial therapy and surgical prophylaxis. The minimum time dedicated to AMS teaching differed between institutions (range 9-119 h), teaching was generally through didactic methods, and assessment was generally through knowledge recall and objective structured clinical examinations. Feedback from students suggests they find AMS and antimicrobial resistance (AMR) to be complex yet important topics. CONCLUSIONS UK schools of pharmacy should utilize the competency framework to identify gaps in their AMS, AMR and infection teaching. To prepare newly qualified pharmacists to be effective at delivering AMS and prescribing antimicrobials, schools of pharmacy should utilize more simulated environments and clinical placements for education and assessment of AMS.
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Affiliation(s)
- Ryan A Hamilton
- School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, Wales
| | - Kevin J Frost
- Pharmacy Department, Airedale NHS Foundation Trust, Keighley BD20 6TD, UK
| | - Roger Harrison
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PT, UK
| | - Helen Root
- School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK
| | - David G Allison
- Division of Pharmacy & Optometry, The University of Manchester, Manchester M13 9PT, UK
| | - Antonella P Tonna
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen AB10 7AQ, UK
| | - Diane Ashiru-Oredope
- School of Pharmacy, University College London, London WC1N 1AX, UK
- UK Health Security Agency, London SW1P 3JR, UK
| | - Mamoon A Aldeyab
- Department of Pharmacy, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Katherine Shemilt
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Sandra J Martin
- School of Pharmacy & Medical Sciences, University of Bradford, Bradford BD7 1DP, UK
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Abou El Fadl DK, Aly YAF, Darweesh EAG, Sabri NA, Ahmed MA. Assessment of neonatal intensive care unit nurses' compliance with standard precautions of infection control and identification of enabling factors. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2023; 9:6. [PMID: 36711251 PMCID: PMC9870194 DOI: 10.1186/s43094-022-00456-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/23/2022] [Indexed: 01/24/2023] Open
Abstract
Background Rigorous implementation of infection prevention and control practices by healthcare workers in different healthcare settings is of utmost importance. Neonates, particularly preterm babies in neonatal intensive care units, are a vulnerable population at high risk for developing nosocomial infections. Nurses have the greatest risk of spreading healthcare-associated infections among patients and healthcare workers. This study was conducted to assess the compliance of neonatal intensive care unit nurses with standard precautions of infection control and to identify the potential influencing factors. Results This was a cross-sectional study, whereby the compliance of a total of 58 neonatal intensive care unit nurses with standard precautions of infection control was assessed using the Arabic version of the Compliance with Standard Precautions Scale (CSPS-A). Student's t test, ANOVA test, and post hoc test were used for analysis.A suboptimal compliance rate (66.7%) was detected, with the highest for disposal of sharp articles into sharps boxes (86.2%) and the lowest for disposal of sharps box not only when full (27.6%). Significant differences were observed when participants were grouped according to their clinical experience and qualifications, where participants with longer clinical experience displayed higher mean scores for the use of protective devices score (P = 0.024), disposal of sharps score (P = 0.003), and total CSPS score (P = 0.006). Conclusions Clinical experience and educational qualifications are key factors that impact nurses' compliance with infection control practices. Nurses should receive up-to-date evidence-based educational and practical sessions that link theory to clinical practice and elucidate the importance of accurate implementation of proper infection prevention and control practices.
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Affiliation(s)
- Dina K. Abou El Fadl
- grid.440865.b0000 0004 0377 3762Pharmacy Practice & Clinical Pharmacy Department, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Yasmin A. F. Aly
- grid.7269.a0000 0004 0621 1570Paediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ebtissam Abdel Ghaffar Darweesh
- grid.440865.b0000 0004 0377 3762Pharmacy Practice & Clinical Pharmacy Department, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Nagwa A. Sabri
- grid.7269.a0000 0004 0621 1570Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Marwa Adel Ahmed
- grid.7269.a0000 0004 0621 1570Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Cairns KA, Avent M, Buono E, Cheah R, Devchand M, Khumra S, Rawlins M, Roberts JA, Xenos K, Munro C. Standard of practice in infectious diseases for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kelly A. Cairns
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department Alfred Health Melbourne Australia
| | - Minyon Avent
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Queensland State‐Wide Antimicrobial Stewardship Program, Infection and Immunity Theme, UQCCR The University of Queensland Brisbane Australia
| | - Evette Buono
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Clinical Excellence Commission Sydney Australia
- National Centre for Antimicrobial Stewardship Doherty Institute Melbourne Australia
| | - Ron Cheah
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- National Centre for Antimicrobial Stewardship Doherty Institute Melbourne Australia
- Pharmacy Department Monash Health Clayton Australia
| | - Misha Devchand
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Austin Health Heidelberg Australia
| | - Sharmila Khumra
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Austin Health Heidelberg Australia
| | - Matthew Rawlins
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Department of Pharmacy Fiona Stanley Hospital Murdoch Australia
| | - Jason A. Roberts
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- The University of Queensland Centre for Clinical Research Faculty of Medicine & Centre for Translational Anti‐infective Pharmacodynamics School of Pharmacy The University of Queensland Brisbane Australia
- Royal Brisbane and Women’s Hospital Brisbane Australia
- Nîmes University Hospital University of Montpellier Montpellier France
| | - Kristin Xenos
- Infectious Diseases Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Australian Commission on Safety and Quality in Health Care Sydney Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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Sadatsharifi A, Davarpanah MA, Namazi S, Mottaghi S, Mahmoudi L. Economic Burden Of Inappropriate Empiric Antibiotic Therapy: A Report From Southern Iran. Risk Manag Healthc Policy 2019; 12:339-348. [PMID: 31849550 PMCID: PMC6913765 DOI: 10.2147/rmhp.s222200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/08/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Widespread inappropriate antibiotic prescribing by healthcare professionals in the hospital setting is a great concern that may cause many undesirable consequences. Adherences to antibiotic guidelines have proven to be a simple and effective intervention to guide the choice of appropriate empiric antibiotic regimens and reduce the unnecessary variations in the practice among practitioners. The objective of this study was to evaluate the prescription patterns of empiric antibiotic therapy in relation to treatment guidelines and the economic burden of discordance with guidelines in a major referral Iranian university hospital. Method Hospital records of hospitalized patients with empiric antibiotic prescription, from September 2016 to February 2017 were reviewed. The process consisted of comparing empiric antimicrobial administration with institutional guidelines for each patient by a clinical pharmacist and an infectious disease specialist to evaluate the appropriate utilization of antibiotics. Adherence to guideline, the cost of antibiotics usage for each patient and the excess cost consequent from discordance with guideline was calculated. Results The most inappropriate prescribed antibiotics were carbapenems and aminoglycosides. Overall guideline adherence was 27.8%. Frequency of antibiotic usage incompatibility with the guidelines on the basis of dosing interval, duration of therapy and drug indication were 31.46%, 29.44% and 19.36%, respectively. General surgery and internal medicine wards had the least and the most inappropriate antibiotic administration, respectively. Totally antibiotic usage cost was 578,959.39 USD (24,316,294,800 Iranian Rials, IRR) for 6 months, which the excess costs of inappropriate antibiotic prescribing, was 471,319.69 USD (19,795,427,225 IRR). The estimated annual excess cost is 942,639.38 USD (39,590,854,450 IRR). Conclusion In this research, physicians’ adherence with guidelines for empiric antibiotic therapy was low which was led to 471,319.69 USD excess costs. These results urge institution policy makers to develop guidelines to ensure active dissemination and implementation of them to decrease inappropriate antibiotic usage.
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Affiliation(s)
- Arman Sadatsharifi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Soha Namazi
- Department of Clinical Pharmacy, School of pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Mottaghi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Woodard L, Kahaleh A, Nash J, Truong H, Gogineni H, Barbosa-Leiker C. Healthy People 2020: assessment of pharmacists' priorities. Public Health 2018; 155:69-80. [DOI: 10.1016/j.puhe.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/17/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
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Beach JE, Ramsey TD, Gorman SK, Lau TTY. Roles of Infectious Diseases Consultant Pharmacists and Antimicrobial Stewardship Pharmacists: A Survey of Canadian Tertiary Care Academic Hospitals. Can J Hosp Pharm 2017; 70:415-422. [PMID: 29299000 DOI: 10.4212/cjhp.v70i6.1709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Infectious diseases consultant (IDC) pharmacists work within an IDC service to care for inpatients with complex infections. With Accreditation Canada's new Required Organizational Practice promoting the establishment of antimicrobial stewardship (AMS) programs, AMS pharmacists are being employed in acute care hospitals. There is potential for overlap in responsibilities between IDC and AMS pharmacists, but there is no literature outlining the current duties for each group in Canada. Objective To describe the demographic characteristics and roles of IDC and AMS pharmacists in Canadian tertiary care academic hospitals. Methods A survey of IDC and AMS pharmacists at Canadian tertiary care academic hospitals was conducted between February and April 2015. The questionnaire included questions about the pharmacist's experience, education, and training; the institution where the pharmacist was practising; the IDC or AMS team characteristics; and the pharmacist's roles in clinical, educational, administrative, and research sectors. Results The survey response rate was 77% (68/88). The 68 respondents self-identified as IDC pharmacists (14 [21%]), AMS pharmacists (34 [50%]), or dual-role IDC and AMS pharmacists (20 [29%]). Compared with AMS pharmacists, IDC pharmacists reported more of the following unique clinical activities: directly communicating with patients, attending rounds, involving patients in decision-making, and providing patient education. The 3 groups of pharmacists described similar educational responsibilities. The AMS pharmacists performed more of the following administrative and research duties: development of antibiograms and preprinted orders, collection of antimicrobial metrics, and drug-use evaluations for antimicrobials. Dual-role IDC and AMS pharmacists were involved in fewer of the unique activities described by those who practised within a single subspecialty. Conclusions Self-identified IDC and AMS pharmacists in Canadian tertiary care academic hospitals were performing many similar roles; however, distinct differences within the clinical, administrative, and research domains were identified among IDC pharmacists, AMS pharmacists, and those who identified as dual-role IDC and AMS pharmacists.
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Affiliation(s)
- Jessica E Beach
- , BSc(Pharm), ACPR, PharmD, was, at the time of this study, a Pharmacy Resident with Interior Health Authority, British Columbia. She is now with the Pharmacy Department, Royal Inland Hospital, Kamloops, British Columbia
| | - Tasha D Ramsey
- , BSc(Pharm), ACPR, PharmD, is with the Pharmacy Department, Nova Scotia Health Authority, and the College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | - Sean K Gorman
- , BSc(Pharm), ACPR, PharmD, is with the Pharmacy Department, Kelowna General Hospital, Kelowna, British Columbia, and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Tim T Y Lau
- , BSc(Pharm), PharmD, ACPR, FCSHP, is with Pharmaceutical Sciences, Vancouver General Hospital, and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
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7
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de With K, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T, Fellhauer M, Geiss HK, Janata O, Krause R, Lemmen S, Meyer E, Mittermayer H, Porsche U, Presterl E, Reuter S, Sinha B, Strauß R, Wechsler-Fördös A, Wenisch C, Kern WV. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection 2017; 44:395-439. [PMID: 27066980 PMCID: PMC4889644 DOI: 10.1007/s15010-016-0885-z] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction In the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute. Materials and methods A structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development. Conclusion The guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.
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Affiliation(s)
- K de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus at the TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - F Allerberger
- Division Public Health, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - S Amann
- Hospital Pharmacy, Munich Municipal Hospital, Munich, Germany
| | - P Apfalter
- Institute for Hygiene, Microbiology and Tropical Medicine (IHMT), National Reference Centre for Nosocomial Infections and Antimicrobial Resistance, Elisabethinen Hospital Linz, Linz, Austria
| | - H-R Brodt
- Department of Infectious Disease Medical Clinic II, Goethe-University Frankfurt, Frankfurt, Germany
| | - T Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - M Fellhauer
- Hospital Pharmacy, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - H K Geiss
- Department of Hospital Epidemiology and Infectiology, Sana Kliniken AG, Ismaning, Germany
| | - O Janata
- Department for Hygiene and Infection Control, Danube Hospital, Vienna, Austria
| | - R Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - S Lemmen
- Division of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Aachen, Germany
| | - E Meyer
- Institute of Hygiene and Environmental Medicine, Charité, University Medicine Berlin, Berlin, Germany
| | - H Mittermayer
- Institute for Hygiene, Microbiology and Tropical Medicine (IHMT), National Reference Centre for Nosocomial Infections and Antimicrobial Resistance, Elisabethinen Hospital Linz, Linz, Austria
| | - U Porsche
- Department for Clinical Pharmacy and Drug Information, Landesapotheke, Landeskliniken Salzburg (SALK), Salzburg, Austria
| | - E Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - S Reuter
- Clinic for General Internal Medicine, Infectious Diseases, Pneumology and Osteology, Klinikum Leverkusen, Leverkusen, Germany
| | - B Sinha
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Strauß
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, University Hospital Erlangen, Erlangen, Germany
| | - A Wechsler-Fördös
- Department of Antibiotics and Infection Control, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - C Wenisch
- Medical Department of Infection and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - W V Kern
- Division of Infectious Diseases, Department of Medicine, Freiburg University Medical Center, Freiburg, Germany
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8
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Heath CH, Orrell CT, Lee RC, Pearman JW, McCullough C, Christiansen KJ. A review of the Royal Perth Hospital Bali experience: an infection control perspective. ACTA ACUST UNITED AC 2016; 8:43-54. [PMID: 32288537 PMCID: PMC7146777 DOI: 10.1071/hi03043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Thirty five patients were transferred to Royal Perth Hospital (RPH) after the Bali bombings. The patients had severe burn injuries and were considered to be at high-risk of both the carriage and acquisition of multi-resistant organisms (MROs). Whilst seeking to protect the Bali patients with a comprehensive infection control response, we also sought to protect other high-risk patients from nosocomial acquisition of MROs. MROs were detected from 25 (82%) of the 29 Bali patients admitted to RPH. Bali patients were colonised, or infected, with one or more of the following MROs: multi-resistant Acinetobacter baumannii (MRAB) (19 patients), extended-spectrum ß-lactamase (ESBL) producing Gram-negative bacteria (15 patients), vancomycin-resistant enterococci (VRE) (nine patients), multi-resistant Pseudomonas aeruginosa (MRPA) (six patients), multi-resistant Chryseobacterium sp. (four patients), and methicillin-resistant Staphylococcus aureus (MRSA) (three patients). Five Bali patients developed a total of eight bacteraemic episodes, with MRPA sepsis contributing to death in two patients. Since the Bali bombings horizontal transmission of Bali MROs has occurred in 41 non-Bali patients in RPH. MRPA has had the greatest clinical impact. Eight non-Bali patients developed a total of 11 bacteraemic episodes, with MRPA sepsis contributing to death in four patients. However, apart from MRPA, we have now controlled transmission of the other MROs in RPH. The emergency response to the Bali disaster required strong leadership, good communication and multi-disciplinary teamwork. The infection control strategy contributed to good outcomes for most Bali bombing patients. However, many patients within the Bali cohort were heavily colonised with MROs, and some developed invasive infection. Subsequent nosocomial transmission of these MROs to non-Bali patients has been a legacy of the Bali tragedy.
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Affiliation(s)
- Christopher H Heath
- Department of Microbiology & Infectious Diseases, Infection Management Service, Royal Perth Hospital, Perth WA.,Clinical Senior Lecturer in Medicine, Faculty of Medicine & Pharmacology, University of Western Australia, WA.,Department of Microbiology & Infectious Diseases, Infection Management Service, Royal Perth Hospital, Perth WA.,Department of Microbiology & Infectious Diseases, Infection Management Service, Royal Perth Hospital, Perth WA.,Adjunct Professor, School of Biomedical Sciences Curtin University of Technology, WA.,Department of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth WA.,Adjunct Associate Professor, School of Biomedical Sciences, Curtin University of Technology, WA
| | - C Terri Orrell
- Department of Microbiology & Infectious Diseases, Infection Management Service, Royal Perth Hospital, Perth WA.,Department of Microbiology & Infectious Diseases, Infection Management Service, Royal Perth Hospital, Perth WA.,Adjunct Professor, School of Biomedical Sciences Curtin University of Technology, WA.,Department of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth WA.,Adjunct Associate Professor, School of Biomedical Sciences, Curtin University of Technology, WA
| | - Rosie Ce Lee
- Department of Microbiology & Infectious Diseases, Infection Management Service, Royal Perth Hospital, Perth WA.,Adjunct Professor, School of Biomedical Sciences Curtin University of Technology, WA.,Department of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth WA.,Adjunct Associate Professor, School of Biomedical Sciences, Curtin University of Technology, WA
| | - John W Pearman
- Adjunct Professor, School of Biomedical Sciences Curtin University of Technology, WA.,Department of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth WA.,Adjunct Associate Professor, School of Biomedical Sciences, Curtin University of Technology, WA
| | - Cheryll McCullough
- Department of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth WA.,Adjunct Associate Professor, School of Biomedical Sciences, Curtin University of Technology, WA
| | - Keryn J Christiansen
- Adjunct Associate Professor, School of Biomedical Sciences, Curtin University of Technology, WA
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Gilchrist M, Wade P, Ashiru-Oredope D, Howard P, Sneddon J, Whitney L, Wickens H. Antimicrobial Stewardship from Policy to Practice: Experiences from UK Antimicrobial Pharmacists. Infect Dis Ther 2015; 4:51-64. [PMID: 26362295 PMCID: PMC4569645 DOI: 10.1007/s40121-015-0080-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 11/28/2022] Open
Abstract
Antimicrobial stewardship in the UK has evolved dramatically in the last 15 years. Factors driving this include initial central funding for specialist pharmacists and mandatory reductions in healthcare-associated infections (particularly Clostridium difficile infection). More recently, the introduction of national stewardship guidelines, and an increased focus on stewardship as part of the UK five-year antimicrobial resistance strategy, have accelerated and embedded developments. Antimicrobial pharmacists have been instrumental in effecting changes at an organizational and national level. This article describes the evolution of the antimicrobial pharmacist role, its impact, the progress toward the actions listed in the five-year resistance strategy, and novel emerging areas in stewardship in the UK.
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Affiliation(s)
- Mark Gilchrist
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
| | - Paul Wade
- Guy's and St. Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | | | - Philip Howard
- Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, 50 West Nile Street, Glasgow, G1 2NP, UK
| | - Laura Whitney
- St George's University Hospital NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Hayley Wickens
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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10
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DRUGS system enhancing adherence of Chinese surgeons to antibiotic use guidelines during perioperative period. PLoS One 2014; 9:e102226. [PMID: 25148306 PMCID: PMC4141742 DOI: 10.1371/journal.pone.0102226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/17/2014] [Indexed: 11/19/2022] Open
Abstract
Objective Irrational use of antimicrobial agents for preventing postoperative SSIs is a common phenomenon in China, which results in more bacterial resistance, higher hospital infection rates, extra costs of antimicrobial agents. The aim of the study is to evaluate the effect of Drug Rational Usage Guidelines System (DRUGS) on the surgeon's prescription behavior of antimicrobial agents. Methods 10 common surgical operations which included 1543 cases (where 778 cases using paper-based guidelines and 765 cases using DRUGS) were selected and their demographic and clinical data were collected. The selected operations include thyroid resection, breast mass resection, myomectomy, etc. The evaluation criteria were antibiotic administrative categories, the time of initial dose, duration of administration, length of stay, the costs of antibiotics, SSIs and drug adverse reactions(ADR). Results The antimicrobial agents were mostly administrated within 0.5 h to 2 h before incision, 656 patients (85.75%) were intervened with DRUGS and 256 (32.90%) with paper-based guidelines according to the protocol. For the clean wounds incision, 547 patients (91.62%) were within 24 h of withdrawal antibiotics with using paper-based guidelines versus 91 (14.79%) with using DRUGS. A total of 19 kinds of antibiotics were used in the 1543 cases. The leading three on the list of frequency were piperacillin and sulbactam sodium, cefathiamidine and cefoperazone. While after the intervention, the list of frequency changed to cefazolin, cefathiamidine, cefoperazone. The average hospital stay was (7.00±4.31)d with paper-based guidelines and (2.54±1.57)d with DRUGS, respectively. The average cost of antibiotics was ¥(3481.36±2584.46) with paper-based guidelines and ¥(1693.39±1478.27) with DRUGS, respectively. However, there were no significant differences in the incidence of SSIs and ADR between two groups. Conclusion In this study, the increased availability of antibiotic guidelines at the time of drug ordering, combined with DRUGS, was associated with an enhanced surgeon adherence to guidelines.
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11
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Friedman ND. Antimicrobial Stewardship: The Need to Cover All Bases. Antibiotics (Basel) 2013; 2:400-18. [PMID: 27029310 PMCID: PMC4790271 DOI: 10.3390/antibiotics2030400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/18/2013] [Accepted: 08/21/2013] [Indexed: 12/18/2022] Open
Abstract
Increasing antimicrobial resistance has necessitated an approach to guide the use of antibiotics. The necessity to guide antimicrobial use via stewardship has never been more urgent. The decline in anti-infective innovation and the failure of currently available antimicrobials to treat some serious infections forces clinicians to change those behaviors that drive antimicrobial resistance. The majority of antimicrobial stewardship (AMS) programs function in acute-care hospitals, however, hospitals are only one setting where antibiotics are prescribed. Antimicrobial use is also high in residential aged care facilities and in the community. Prescribing in aged care is influenced by the fact that elderly residents have lowered immunity, are susceptible to infection and are frequently colonized with multi-resistant organisms. While in the community, prescribers are faced with public misconceptions about the effectiveness of antibiotics for many upper respiratory tract illnesses. AMS programs in all of these locations must be sustainable over a long period of time in order to be effective. A future with effective antimicrobials to treat bacterial infection will depend on AMS covering all of these bases. This review discusses AMS in acute care hospitals, aged care and the community and emphasizes that AMS is critical to patient safety and relies on government, clinician and community engagement.
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Affiliation(s)
- N Deborah Friedman
- Barwon Health, Bellerine St, Geelong, VIC 3220, Australia.
- Deakin University, Geelong, VIC 3216, Australia .
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Weber RJ, Xu F, Bonkowski J. Enhancing Practice Models by Recruiting Pharmacists with Specialty Training. Hosp Pharm 2012. [DOI: 10.1310/hpj4705-390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Director's Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Evaluation of pharmacy practice models across the country promotes the expansion of clinical pharmacy services; some organizations may recruit pharmacists with specialty training. Specialty practice pharmacists are pharmacists who have extensive knowledge and experience in a particular area of pharmacy. Networking is a critical strategy in recruiting the best candidates for specialty roles. This article presents several strategies to assist pharmacy directors in hiring specialty trained pharmacists to enhance their practice model. These strategies apply to building practice models from small hospitals to large academic medical centers. Ultimately, recruitment of the best pharmacists to join the patient care team helps to build the best patient-centered pharmacy service.
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Affiliation(s)
- Robert J. Weber
- Wexner Medical Center at Ohio State University, Columbus, Ohio
| | - Fuwang Xu
- The Ohio State University College of Pharmacy, Columbus, Ohio
| | - Joseph Bonkowski
- Health-System Pharmacy Administration, Wexner Medical Center at Ohio State University, Columbus, Ohio
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13
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Kaku M. [Expectations for the pharmacists in the management of infectious diseases]. YAKUGAKU ZASSHI 2012; 131:1403-5. [PMID: 21963965 DOI: 10.1248/yakushi.131.1403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the 21 century, the management of infectious diseases has become increasingly important. Especially, the establishment of the infection prevention and control system is very important in the healthcare-settings for patient safety. And from this background, infection control teams (ICT) which perform the infectious diseases management have been organized in many institutions. These ICT members are medical doctors, nurses, medical technologists and pharmacists and the role of the pharmacist in the ICT is very important. The pharmacist should play a role as a specialist for antimicrobial agents, antiseptics and disinfectants. The roles and responsibilities of the pharmacist for infection control are leading the antimicrobial stewardship, promoting the appropriate and rational use of antimicrobial agents, advising the health system on the selection and use of appropriate antiseptics, disinfectants and sterilants, developing guidelines for risk assessment, treatment, and monitoring of patients and health care workers. Establishing internal pharmacy policies, procedures and quality control programs to prevent contamination, educating health professionals, patients, and the public activity are also included. It is expected that the infection control pharmacist should contribute to the management of infectious diseases and patient safety in the healthcare-settings.
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Affiliation(s)
- Mitsuo Kaku
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University, Graduate School of Medicine, Sendai, Japan.
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Edwards R, Drumright L, Kiernan M, Holmes A. Covering more Territory to Fight Resistance: Considering Nurses' Role in Antimicrobial Stewardship. J Infect Prev 2011; 12:6-10. [PMID: 21532974 DOI: 10.1177/1757177410389627] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The potential contribution nurses can make to the management of antimicrobials within an in-patient setting could impact on the development of antimicrobial resistance (AMR) and healthcare associated infections (HCAIs). Current initiatives promoting prudent antimicrobial prescribing and management have generally failed to include nurses, which subsequently limits the extent to which these strategies can improve patient outcomes. For antimicrobial stewardship (AS) programmes to be successful, a sustained and seamless level of monitoring and decision making in relation to antimicrobial therapy is needed. As nurses have the most consistent presence as patient carer, they are in the ideal position to provide this level of service. However, for nurses to truly impact on AMR and HCAIs through increasing their profile in AS, barriers and facilitators to adopting this enhanced role must be contextualised in the implementation of any initiative.
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Affiliation(s)
- R Edwards
- The National Centre for Infection Prevention and Management, Division of Infectious Diseases, Imperial College London, London, W12 OHS, UK
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15
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Deuster S, Roten I, Muehlebach S. Implementation of treatment guidelines to support judicious use of antibiotic therapy. J Clin Pharm Ther 2010; 35:71-8. [PMID: 20175814 DOI: 10.1111/j.1365-2710.2009.01045.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Judicious use of antibiotics is essential considering the growth of antimicrobial resistance and escalating costs in health care. This intervention study used treatment guidelines to improve antibiotic therapy by changing prescribing practice. METHODS A before-after intervention study was performed in a 550-bed tertiary care teaching hospital in Switzerland, with an additional follow-up analysis 1 year later. The pre-intervention phase included chart analysis of current antibiotic use in 100 consecutive patients from the representative medical and surgical wards included in the study. Treatment guidelines were defined, taking into account published guidelines, the local antibacterial sensitivity of the pathogens, and the hospital antibiotic formulary defined by the drug and therapeutics committee. The guidelines were presented to the medical residents on a pocket card. They were informed and educated by the pharmacist (intervention). In the post-intervention phase immediately after the instruction, and in the follow-up phase 1 year later, a prospective analysis of antibiotic prescription was performed by chart review of 100 antibacterial treatments in consecutive patients to detect changes in antibiotic prescribing (treatment) and to determine whether these changes were sustained. RESULTS The pre-intervention review of antibiotic use showed the need for therapy improvements in urinary tract infections (UTI) and hospital-acquired pneumonia (HAP). In the post-intervention phase 100% of UTI were treated as recommended, compared to 30% before the intervention (P < 0.001). The follow-up analysis showed a decrease in guideline adherence to 39% in patients with UTI. Before implementation of the clinical guidelines, HAP was inappropriately treated like community-acquired pneumonia (CAP). Immediately after the intervention, 50% of HAP patients were treated as recommended, and 1 year later (follow-up phase) 56% of HAP patients received the recommended antibiotic medication. This change in prescription practice was significant (P < 0.05). CONCLUSION Antibiotic treatment guidelines for the infections most commonly occurring in hospitalized patients resulted in a significant increase in appropriate antibiotic use. The program was successful in changing prescription practice and achieved a sustained optimization of HAP therapy. Implementing, teaching and monitoring treatment guidelines can have a major impact on patient care.
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Affiliation(s)
- S Deuster
- Division of Pharmacy, University Hospital Basel, Basel, Switzerland.
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Woodford EM, Wilson KA, Marriott JF. Antibiotic prescribing control by pharmacists within UK NHS hospitals. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/0022357023673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To identify the role of clinical pharmacists in antibiotic prescribing control.
Method
A self-completion postal questionnaire was sent to the chief pharmacist at 465 UK National Health Service hospitals in 2001/2002. It contained questions covering hospital demographics and the role of pharmacists in ensuring adherence with the recommendations on antibiotic prescribing contained in hospital prescribing documents.
Key findings
Fifty-four per cent of questionnaires (n=253) were completed. Of these, 93% (n=235) of the responding hospitals had at least one of the following prescribing control documents: antibiotic formulary, antibiotic policy and antibiotic guidelines. Pharmacists routinely performed clinical review of adherence with prescribing recommendations (antibiotic prescribing control) in 83% of the responding hospitals but only in approximately two-thirds of hospitals (64%) was this review performed on every ward. The antibiotic prescribing control process appeared to be thorough, with five review activities performed by pharmacists in the majority of hospitals (74%), and proactive, with pharmacists undertaking routine daily visits to all wards (or selected units) in 85% of responding hospitals. Nearly three-quarters (71%) of hospitals had performed an audit of antibiotic prescribing; the majority had done so within the past two years. Pharmacists had been involved in these audits in 92% of responding hospitals.
Conclusions
Where performed, antibiotic prescribing control appeared to be a thorough process. Key areas for service improvement are extension of antibiotic prescribing control to all wards and the standardisation of intervention documentation. Barriers preventing the provision of a comprehensive clinical pharmacy service are discussed and future strategies identified.
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Affiliation(s)
| | - Keith Alan Wilson
- The Pharmacy Practice Research Group, Aston University, Birmingham, England
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Scheetz MH, Bolon MK, Postelnick M, Noskin GA, Lee TA. Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis. J Antimicrob Chemother 2009; 63:816-25. [PMID: 19202150 DOI: 10.1093/jac/dkp004] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We sought to determine the cost-effectiveness of Antimicrobial Stewardship Teams (ASTs) on the reduction of morbidity and mortality associated with nosocomial bacteraemia. METHODS A decision analytic model compared costs and outcomes of bacteraemic patients receiving standard treatment with or without an AST consult. Patients with a bacteraemic event during their hospital admission were included in the model. Effectiveness was estimated as quality-adjusted life years (QALYs) over the lifetime of patients. Model variables and costs, along with their distributions, were obtained from the literature and expert opinion. Incremental cost-effectiveness ratios (ICERs) were calculated to estimate the cost per QALY gained from the hospital perspective. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. The cost-effectiveness of clinical decision support systems was evaluated as a secondary analysis. RESULTS Implementing an AST for bacteraemia review cost $39,737 (95% CI $27,272-53, 017) and standard treatment cost $39,563 (95% CI $27,164-52,797). The difference in effectiveness between the two strategies was 0.08 QALYs, and the base case ICER from the probabilistic analysis was $2367 per QALY gained [95% CI dominant (less costly, more effective) to $24,379]. Results from the probabilistic sensitivity analysis demonstrated there was more than a 90% likelihood that an AST would be cost-effective at a level of $10,000 per QALY. CONCLUSIONS Maintaining an AST to improve care for bacteraemia is cost-effective from the hospital perspective. The estimate of $2367 per QALY gained for the AST intervention compares favourably with many currently funded healthcare interventions and services.
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Affiliation(s)
- Marc H Scheetz
- Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA.
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19
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Antimicrobial optimisation in secondary care: the pharmacist as part of a multidisciplinary antimicrobial programme—a literature review. Int J Antimicrob Agents 2008; 31:511-7. [DOI: 10.1016/j.ijantimicag.2008.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 11/22/2022]
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KATAYAMA T. Necessity of Pharmacist Promotion to Contribute for Infection Control and Building Patient Safety. YAKUGAKU ZASSHI 2007; 127:1789-95. [DOI: 10.1248/yakushi.127.1789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Khan MTH. Antiviral and Antimicrobial Evaluation of Some Heterocyclic Compounds from Turkish
Plants. BIOACTIVE HETEROCYCLES V 2007; 11. [PMCID: PMC7120619 DOI: 10.1007/7081_2007_072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antibiotic resistance has become a problem since the discovery of antibiotics. Not long after
the introduction of penicillin, Staphylococcus aureus, which can be also
transmitted to humans via milk and milk products, began developing penicillin-resistant strains. Therefore,
one approach that has been used for the discovery of new antimicrobial agents from natural sources is based
on the evaluation of traditional plant extracts. Natural products have played a pivotal role in antibiotic
drug innovation and include aminoglycosides, cephalosporins, macrolides, cycloserine, novobiocin, and lipoproteins.
However, only a few antiviral agents are available on the market. To this purpose, we have screened
a great number of herbal extracts along with some pure natural substances and obtained interesting
findings. This chapter covers the results of our rigorous search for new antiviral and antimicrobial alternative
compounds from a number of Turkish plants.
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Abstract
Specialist pharmacists have become an established feature of the antibiotic stewardship landscape in hospitals throughout the UK over the last decade. This review examines the origins of the specialist antibiotic pharmacist and how the role has developed in recent years. Antibiotic pharmacists fulfil a vital function in modern National Health Service hospitals as key members of the infection control team with overall responsibility for initiatives to promote rational antibiotic prescribing. Evidence of the impact of antibiotic pharmacists on clinical, microbiological and financial outcomes is presented along with examples of innovative practice. Finally, a vision for the future of the antibiotic pharmacist role is outlined.
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Affiliation(s)
- Kieran Hand
- Pharmacy Department, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
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Vlahović-Palcevski V, Dumpis U, Mitt P, Gulbinovic J, Struwe J, Palcevski G, Stimac D, Lagergren A, Bergman U. Benchmarking antimicrobial drug use at university hospitals in five European countries. Clin Microbiol Infect 2007; 13:277-83. [PMID: 17391382 DOI: 10.1111/j.1469-0691.2006.01613.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A point-prevalence survey of five European university hospitals was performed to benchmark antimicrobial drug use in order to identify potential problem areas in prescribing practice and to aid in establishing appropriate and attainable goals. All inpatients at the university hospitals of Rijeka (Croatia), Tartu (Estonia), Riga (Latvia), Vilnius (Lithuania) and Karolinska-Huddinge (Sweden) were surveyed for antimicrobial drug use during a single day. The frequency of antimicrobial drug use was 24% in Rijeka, 30% in Tartu, 26% in Riga, 14% in Vilnius and 32% in Huddinge. Surgical patients were treated with antimicrobial agents more often than medical patients in Riga (53% vs. 31%), Tartu (39% vs. 26%) and Vilnius (54% vs. 25%). Two-thirds of patients in Rijeka, Tartu, Riga and Vilnius, and fewer than half of the patients in Huddinge, received antimicrobial agents intravenously. Broad-spectrum antimicrobial agents were used most commonly in Rijeka. The prevalence of nosocomial infections treated with antibiotics was 9% at Huddinge, and 3-5% at the other centres. Benchmarking antimicrobial drug use at five university hospitals identified differences and problem areas. The high rates of intravenous administration, poor compliance with guidelines, and prolonged surgical prophylaxis were general problems that deserved specific attention at all centres. A change in prescription practices may reduce unnecessary drug use and decrease antimicrobial resistance.
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Affiliation(s)
- V Vlahović-Palcevski
- Department of Clinical Pharmacology, University Hospital Rijeka, University of Rijeka Medical School, Rijeka, Croatia.
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von Gunten V, Reymond JP, Beney J. Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review. ACTA ACUST UNITED AC 2007; 29:146-63. [PMID: 17273907 DOI: 10.1007/s11096-006-9042-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 06/20/2006] [Indexed: 10/23/2022]
Abstract
AIM OF THE REVIEW To identify and review the clinical and economic impact of pharmacists' interventions on antibiotic use. METHOD A literature search was conducted on Medline (1966-2003) to identify original articles measuring the impact of pharmacists' interventions on antimicrobial therapy at patient's or prescriber's level. RESULTS Forty-three articles were included: 20 uncontrolled before-after studies, four controlled before-after studies, five controlled trials, 12 randomized controlled trials and two interrupted time series (ITS). The described interventions were grouped into four categories: patient-specific recommendations (pharmacists' interventions concerning patient-specific drug therapy), implementation of policies, education, and therapeutic drug monitoring. These interventions were often combined to provide a multifaceted intervention, making it difficult to isolate the impact of one specific intervention. Measured outcomes were: appropriateness of prescribing (evaluated in 17 studies, 16 showing significant improvement), costs (analysed in 22 studies, nine showing a statistically significant reduction in costs after or with the intervention), and length of hospital stay (mixed results). Other measured outcomes were: drug use, prescriptions, length of treatment, dose intervals, switch to oral route, mortality rate, and treatment failure. CONCLUSION Over the years, the number of studies and quality of methodology has increased. The most frequently observed outcomes with a positive impact were appropriateness of prescribing and cost savings. The vast majority of studies used multiple interventions, in conjunction with pharmacists' recommendations to physicians. Coupled with the use of practice guidelines or educational strategies, these interventions demonstrated a positive impact on economic or clinical outcomes. However, the data are still sparse and sometimes contradictory; therefore, further studies with randomized controlled designs are needed.
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Affiliation(s)
- Vera von Gunten
- Division of Pharmacy, Institut Central des Hôpitaux Valaisans, Sion, Switzerland.
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25
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Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2006; 44:159-77. [PMID: 17173212 DOI: 10.1086/510393] [Citation(s) in RCA: 2301] [Impact Index Per Article: 127.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 10/04/2006] [Indexed: 12/31/2022] Open
Affiliation(s)
- Timothy H Dellit
- Harborview Medical Center and the University of Washington, Seattle, USA
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Wickens HJ, Jacklin A. Impact of the Hospital Pharmacy Initiative for promoting prudent use of antibiotics in hospitals in England. J Antimicrob Chemother 2006; 58:1230-7. [PMID: 17030518 DOI: 10.1093/jac/dkl405] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In July 2003, the UK Department of Health announced an allocation of 12 million pounds sterling to hospital pharmacists to improve the monitoring and control of anti-infective use over the ensuing 3 year period (the Hospital Pharmacy Initiative, or HPI). Chief Pharmacists were asked to use this money for developments to promote prudent antibiotic use and monitoring of antimicrobials within their Trusts. This study aimed to evaluate the impact of the HPI funding, which at the time had been in place for nearly 2 years, on pharmacy activities in this area. METHODS A postal questionnaire was sent to the pharmacy department of each acute hospital Trust in England, aiming to provide a descriptive overview of the activities of hospital pharmacy staff in the field of anti-infectives and to explore the extent to which these activities were made possible by the HPI funding. RESULTS One hundred and forty-one specialist antimicrobial pharmacy staff were employed in 130 responding Trusts; 89% were pharmacists, 7% pharmacy technicians and the remainder administrative staff. Three-quarters of these staff had been employed due to the funding, resulting in review of antimicrobial prescribing guidelines, antibiotic audit projects and multidisciplinary work with Microbiology/Infectious Diseases staff. Thirteen Trusts gave details of drug acquisition cost savings; over the course of a year, these Trusts saved 1.1 million pounds sterling in total. CONCLUSIONS The HPI funding has facilitated greater interaction between Pharmacy and Microbiology/Infectious Diseases departments than was previously possible. Significant reductions in antibiotic acquisition costs have been demonstrated, though further work is warranted to fully establish the impact of pharmacy activities on clinical and microbiological outcomes.
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Affiliation(s)
- H J Wickens
- Pharmacy Department, St Mary's NHS Trust, London W2 1NY, UK.
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Abstract
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.
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Affiliation(s)
- Conan MacDougall
- Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia 23298, USA.
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Usluer G, Ozgunes I, Leblebicioglu H. A multicenter point-prevalence study: antimicrobial prescription frequencies in hospitalized patients in Turkey. Ann Clin Microbiol Antimicrob 2005; 4:16. [PMID: 16202139 PMCID: PMC1276781 DOI: 10.1186/1476-0711-4-16] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 10/03/2005] [Indexed: 11/22/2022] Open
Abstract
Background Accurate information about prescribing patterns in hospitals is valuable in improving the quality of antimicrobial prescriptions. Methods Data on the use of antimicrobial agents in eighteen tertiary care hospitals were collected on March 20th 2002. Results One or more antimicrobials were ordered in 2900 (30.6 %)of 9471 hospitalized patients. The reasons of hospitalization of the patients receiving antimicrobials were medical treatment (42.5 %), elective surgery (39.6 %), treatment of infectious disease (17.1 %) and emergent surgical procedures (10.4 %). The highest consumption frequencies were found in surgical (81.6 %) and medical (55.2 %) intensive care units. The 48.8 % of antimicrobials were given for treatment and 44.2 % for prophylactic use. The most common reasons for treatment were found as lower respiratory tract, urinary tract, surgical wound infections and febrile neutropenia. Antimicrobials were ordered empirically in 78.4 % of patients. The proven infection ratio was found as 30.7 %. The 56.4 % and 13.4 % of orders were evaluated as clinically and microbiologically appropriate respectively. Conclusion These results suggest that antimicrobial prescription and empirical treatment ratios were high and inappropriate at inpatient groups.
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Affiliation(s)
- Gaye Usluer
- Osmangazi University, Faculty of Medicine, Department of Infectious Diseases, Eskisehir-Turkey
| | - Ilhan Ozgunes
- Osmangazi University, Faculty of Medicine, Department of Infectious Diseases, Eskisehir-Turkey
| | - Hakan Leblebicioglu
- Ondokuz Mayis University, Faculty of Medicine, Department of Infectious Diseases, Samsun-Turkey
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McLaughlin CM, Bodasing N, Boyter AC, Fenelon C, Fox JG, Seaton RA. Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study. QJM 2005; 98:745-52. [PMID: 16126741 DOI: 10.1093/qjmed/hci114] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A high proportion of medical in-patients in the UK receive intravenous (IV) antibiotic therapy. This may be inappropriate in non-severe infections, or unnecessarily prolonged. AIM To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital. DESIGN Observational intervention study. METHODS Data relating to infection and antibiotic therapy were collected for 4 weeks pre-intervention (group 1) and 4 weeks post intervention (group 2). Six months later, data were collected for a further 4 weeks following a second intervention (group 3). Interventions consisted of pharmacy-led implementation of guidelines incorporating criteria for IV therapy and switching to the oral route. The second intervention also included pharmacy-initiated feedback on prescribing. The main outcome measures were IV antibiotic duration, and appropriateness of the IV route and switching. RESULTS Of 2365 admissions, 757 (32%) had 806 treated episodes. IV therapy was used in 40%, 46% and 36% (groups 1, 2 and 3, respectively) and was appropriate in 92% vs. 100% (group 1 vs. 2). In groups 2 and 3, oral switch timing was appropriate in 90% and 88%, vs. 17% in group 1 (p < 0.001). Between groups 1 and 2, median duration of IV therapy was reduced from 3 to 2 days (p = 0.01). More patients in group 2 received appropriate exclusively IV therapy (65% vs. 96%, p < 0.01). Duration of stay in IV-treated patients reduced from 13 to 10 days in groups 2 and 3 (p = 0.047). IV antibiotic expenditure reduced by 13% per patient admitted between groups 1 and 2. DISCUSSION Pharmacy-led introduction of antibiotic guidelines appears to result in clinically appropriate reductions in IV therapy.
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Woodford EM, Wilson KA, Marriott JF. Hospital pharmacists' awareness of a new antibiotic guideline in the UK: implications for practice. ACTA ACUST UNITED AC 2005; 27:215-9. [PMID: 16096890 DOI: 10.1007/s11096-004-1734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pharmacists play an important role in the review of local hospital guidelines. British Thoracic Society (BTS) guidelines for the management of patients with community-acquired pneumonia (CAP) were updated in 2001, and it is important that individual hospital recommendations are based upon this national guidance. The aim of this study was to identify UK Chief Pharmacists' awareness of these updated guidelines one year after their publication. Secondary aims were to identify whether pharmacists had subsequently initiated revision of institutional CAP guidelines, and what roles different professional staff had performed in this process. METHOD A self-completion postal questionnaire was sent to the Chief Pharmacist (or their nominated staff) in 253 UK NHS hospitals in November 2002. This aimed to identify issues relating to their awareness of the 2001 BTS guidelines and subsequent revision of their hospital's guidelines. RESULTS 188 questionnaires were returned (a response rate of 74%), of which 164 hospitals had local antibiotic prescribing guidelines. Respondents in 29% of these hospitals were unaware of the 2001 BTS publication and institutional guidelines had been revised in only 51% of hospitals where the Chief Pharmacist was purportedly aware of the new BTS guidance. Generally, more staff types were involved in revising guidelines than initiating revision. CONCLUSIONS Variability existed in both Chief Pharmacists' awareness of new national guidance and subsequent review processes operating in individual hospitals. A lack of proactive reaction to new national guidance was identified in some hospitals, and it is hoped that the establishment of specialist "infectious diseases pharmacists" will facilitate the review of institutional antibiotic prescribing guidelines in the future.
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Vlahović-Palcevski V, Francetić I, Palcevski G, Novak S, Bergman U. Antimicrobial prescribing at a university hospital: justified or ‘just in case’. Testing a new scoring system as a key quality indicator. Pharmacoepidemiol Drug Saf 2005; 14:561-6. [PMID: 15818638 DOI: 10.1002/pds.1097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the quality of antimicrobial drug prescribing at a university hospital in the Department of Medicine, by using a new scoring system as a quality indicator. METHODS DESIGN a prospective, longitudinal survey, during a 21-week period. The necessity of antimicrobial treatment of all in-patients at the Department of Medicine, to whom new antimicrobials were prescribed, was assessed by using a scoring system based on the presence of signs and symptoms of an infection. If the sum's total score was 3 or more, the antimicrobial treatment was deemed justifiable; if the score was less than 3, the antimicrobial treatment was regarded as questionable. SETTING Department of Medicine (279 hospital-beds) at the University Hospital Center Rijeka, a 1200-patient-bed teaching hospital in Croatia. RESULTS Antimicrobials were prescribed to 15% of the total patients. They were given as a treatment to 89% of the patients, and in 67% of the cases, this treatment was administered empirically. According to the scoring system, 29% of the patients did not have a justified indication for antimicrobial treatment. CONCLUSION The proposed quality indicator (scoring system) that we used is a simple method for the quality assessment of antimicrobial use. It has indicated areas that require in-depth analysis.
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Affiliation(s)
- Vera Vlahović-Palcevski
- Unit for Clinical Pharmacology, University Hospital Center Rijeka, University of Rijeka Medical School, Rijeka, Croatia.
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von Gunten V, Troillet N, Beney J, Boubaker K, Lüthi JC, Taffé P, Reymond JP. Impact of an interdisciplinary strategy on antibiotic use: a prospective controlled study in three hospitals. J Antimicrob Chemother 2005; 55:362-6. [PMID: 15705638 DOI: 10.1093/jac/dki021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Evaluation of the impact of the implementation of practice guidelines, with or without their reinforcement by a pharmacist, on the intra-hospital use of antibiotics. MATERIALS AND METHODS The duration of antibiotic treatment, their cost, and the length of patient stay were compared in three secondary-care hospitals, before and after interventions that were designed to promote rational antibiotic use. After randomization, hospital A received no intervention (control), local practice guidelines were implemented in hospital B (low grade intervention), and these guidelines were reinforced by a clinical pharmacist in hospital C (high grade intervention). Adherence to the guidelines was measured in hospitals B and C. Multivariable statistical analyses were carried out to adjust for confounding factors. RESULTS None of the outcomes measured in the 1200 included patients decreased between the two study periods in any hospital. Hospital A was significantly and independently associated with an increase in the duration of antibiotic treatments, the cost of antibiotics (acquisition and global costs), and the length of stay. Although these differences were not statistically significant, increases in hospital B were higher than in hospital C. Adherence to guidelines was significantly higher in hospital C. CONCLUSIONS Even though interdisciplinary interventions aiming at rationalizing antibiotic use could not diminish the duration of treatments, their costs or the length of stay, they proved useful to control the progression of these parameters.
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Affiliation(s)
- V von Gunten
- Division of Pharmacy, Central Institute of the Valais Hospitals, Sion, Switzerland.
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Cooke FJ, Dean Franklin B, Lawson W, Jacklin A, Holmes A. Multidisciplinary hospital antibiotic stewardship: a West London model. ACTA ACUST UNITED AC 2004. [DOI: 10.1108/14777270410566652] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Woodford EM, Wilson KA, Marriott JF. Professionals' awareness of operational antibiotic prescribing controls in UK NHS hospitals. J Hosp Infect 2004; 58:193-9. [PMID: 15501333 DOI: 10.1016/j.jhin.2004.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2003] [Accepted: 05/24/2004] [Indexed: 11/25/2022]
Abstract
In recent years, there have been increasing recommendations for multidisciplinary collaboration between clinical pharmacists and medical microbiologists in an attempt to control the quality (and quantity) of antibiotic prescribing. A questionnaire addressing the utilization of antibiotic prescribing controls was sent to the chief pharmacist and medical microbiologist in UK NHS hospitals. Responses were received from both the chief pharmacist and the medical microbiologist employed in the same hospital from 83 hospitals (a 30% response rate from two independent studies). A high level of disagreement and poor awareness was identified between the interprofessional staff groups regarding the existence of antibiotic formulary (with disagreement between the two groups, or not known by one or both respondents, in 46% of the paired hospitals, N = 38) and guideline documents (13%, N = 11), performance of antibiotic prescribing audits (40%, N = 33), and whether pharmacists (52%, N = 43) and medical microbiologists (77%, N = 64) monitored physician compliance with antibiotic prescribing control documents. This study has identified poor knowledge of the existence of basic antibiotic prescribing control mechanisms and the role of professional colleagues. It is suggested that there is some way to go before 'Agenda for Change' principles of flexible and collaborative roles are met.
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Affiliation(s)
- E M Woodford
- The Pharmacy Practice Research Group, School of Pharmacy, Aston University, Birmingham B4 7ET, UK.
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Wyllie S, Weeks C, Khachi H, Vickers M, Jones G. Re: Knox K, Lawson W, Dean B, Holmes A. Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist-a UK perspective. J Hosp Infect 2003; 53: 85-90. J Hosp Infect 2003; 54:246. [PMID: 12855244 DOI: 10.1016/s0195-6701(03)00155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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