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Rawlins MD, Boan PA. The impact of positive microbiology results on adherence to antimicrobial stewardship post-prescription review and feedback (PAF) rounds in a quaternary referral center. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e42. [PMID: 36960088 PMCID: PMC10028929 DOI: 10.1017/ash.2023.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Matthew D.M. Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Murdoch, Western Australia
- Author for correspondence: Matthew Rawlins, BPharm, MBA, Department of Pharmacy, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch6150, Western Australia, Australia. E-mail:
| | - Peter A. Boan
- Department of Infectious Disease, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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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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Cairns KA, Rawlins MDM, Unwin SD, Doukas FF, Burke R, Tong E, Henderson AJ, Cheng AC. Building on Antimicrobial Stewardship Programs Through Integration with Electronic Medical Records: The Australian Experience. Infect Dis Ther 2021; 10:61-73. [PMID: 33432535 PMCID: PMC7954903 DOI: 10.1007/s40121-020-00392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022] Open
Abstract
Antimicrobial stewardship (AMS) is well established in Australian hospitals. Electronic medical record (EMR) implementation has lagged in Australia, with two Healthcare Information and Management Systems Society (HIMSS) Stage 6 hospitals and one Stage 7 hospital as of September 2020. Specific barriers faced by AMS teams with paper-based prescribing and medical records include real-time identification of antimicrobials orders; the ability to prospectively monitor antimicrobial use; and the integration of fundamental point of prescribing AMS principles into routine clinical practice. There are few local guidelines to assist Australian hospitals and AMS teams beyond “out of the box” EMR functionality. EMR implementation has enormous potential to positively impact AMS teams through more efficient workflows and the ability to expand the reach and coverage of AMS activities. There are inevitable limitations associated with EMR implementation that must be considered. In this paper, four Australian hospitals share their experience with EMR roll out, AMS customisation and how they have overcome specific barriers in local AMS practice.
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Affiliation(s)
- Kelly A Cairns
- Pharmacy Department, Alfred Health, Melbourne, Australia.
| | | | - Sean D Unwin
- Infection Management Services, Metro South Health, Princess Alexandra Hospital, Woolloongabba, Australia.,Pharmacy Department, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Fiona F Doukas
- Pharmacy Department, Concord Repatriation General Hospital, Sydney, Australia
| | - Rosemary Burke
- Pharmacy and Executive, Sydney Local Health District, Sydney, Australia
| | - Erica Tong
- Pharmacy Department, Alfred Health, Melbourne, Australia
| | - Andrew J Henderson
- Infection Management Services, Metro South Health, Princess Alexandra Hospital, Woolloongabba, Australia.,University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Australia
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MacBrayne CE, Williams MC, Levek C, Child J, Pearce K, Birkholz M, Todd JK, Hurst AL, Parker SK. Sustainability of Handshake Stewardship: Extending a Hand Is Effective Years Later. Clin Infect Dis 2021; 70:2325-2332. [PMID: 31584641 DOI: 10.1093/cid/ciz650] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/11/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Children's Hospital Colorado created a unique method of antimicrobial stewardship, called handshake stewardship, that effectively decreased hospital anti-infective use and costs in its pilot year (2013). Handshake stewardship is distinguished by: (1) the lack of prior authorization; (2) a review of all prescribed anti-infectives; (3) a shared review by the physician and the pharmacist; and (4) a daily, rounding-based, in-person approach to supporting providers. We sought to reevaluate the outcomes of the program after 5 years of experience, totaling 8 years of data. METHODS We retrospectively measured anti-infective (antibiotic, antiviral, antifungal) use hospital-wide by unit and by drug for an 8-year period spanning October 2010 to October 2018. Aggregated monthly use was measured in days of therapy per thousand patient days (DOT/1000 PD). The percentage of children admitted ever receiving an anti-infective was also measured, as well as severity-adjusted mortality, readmissions, and lengths of stay. RESULTS Hospital-wide mean anti-infective use significantly decreased, from 891 (95% confidence interval [CI] 859-923) in the pre-implementation phase to 655 (95% CI 637-694) DOT/1000 PD in post-implementation Year 5; in a segmented regression time series analysis, this was a rate of -2.6 DOT/1000 PD (95% CI -4.8 to -0.4). This is largely attributable to decreased antibacterial use, from 704 (95% CI 686-722) to 544 (95% CI 525 -562) DOT/1000 PD. The percentage of children ever receiving an anti-infective during admission likewise declined, from 65% to 52% (95% CI 49-54). There were no detrimental effects on severity adjusted mortality, readmissions, or lengths of stay. CONCLUSIONS The handshake method is an effective and sustainable approach to stewardship.
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Affiliation(s)
- Christine E MacBrayne
- Department of Pharmacy Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Manon C Williams
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Claire Levek
- Department of Pediatrics and Child Health Research Biostatistical Core, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason Child
- Department of Pharmacy Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Kelly Pearce
- Department of Infection Prevention and Control, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Meghan Birkholz
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - James K Todd
- Department of Pediatrics, Section of Pediatric Infectious Diseases and Department of Infection Prevention and Control, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amanda L Hurst
- Department of Pharmacy Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Sarah K Parker
- Department of Pediatrics, Section of Pediatric Infectious Diseases and Department of Infection Prevention and Control, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Donisi V, Sibani M, Carrara E, Del Piccolo L, Rimondini M, Mazzaferri F, Bovo C, Tacconelli E. Emotional, cognitive and social factors of antimicrobial prescribing: can antimicrobial stewardship intervention be effective without addressing psycho-social factors? J Antimicrob Chemother 2020; 74:2844-2847. [PMID: 31299072 DOI: 10.1093/jac/dkz308] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
There is increasing evidence that psycho-social factors can influence antimicrobial prescribing practice in hospitals and the community, and represent potential barriers to antimicrobial stewardship interventions. Clinicians are conditioned both by emotional and cognitive factors based on fear, uncertainty, a set of beliefs, risk perception and cognitive bias, and by interpersonal factors established through social norms and peer and doctor-patient communication. However, a gap is emerging between research and practice, and no stewardship recommendation addresses the most appropriate human resource allocation or modalities to account for psycho-social determinants of prescribing. There is a need for translation of the evidence available from human behaviour studies to the design and implementation of stewardship interventions and policies at hospital and community levels. The integration of behaviour experts into multidisciplinary stewardship teams seems essential to positively impact on prescribers' communication and decision-making competencies, and reduce inappropriate antibiotic prescribing.
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Affiliation(s)
- V Donisi
- Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - M Sibani
- Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - E Carrara
- Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Del Piccolo
- Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M Rimondini
- Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - F Mazzaferri
- Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - C Bovo
- Medical Direction, University Hospital of Verona, Verona, Italy
| | - E Tacconelli
- Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,Infectious Diseases, Department of Internal Medicine I, Tübingen University, Tübingen, Germany
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Rawlins MDM, Raby E, Sanfilippo FM, Douglass R, Chambers J, McLellan D, Dyer JR. Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds. Int J Qual Health Care 2019; 30:637-641. [PMID: 29733352 DOI: 10.1093/intqhc/mzy088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/09/2018] [Indexed: 01/04/2023] Open
Abstract
Objective To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds). Design Retrospective, single-centre observational study between March 2015 and February 2016. Setting A new quaternary referral centre. Study Participants Adults referred for antimicrobial rounds outside of the intensive care and haematology units. Intervention Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system. Main Outcome Measures The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam. Results Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased. Conclusions The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.
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Affiliation(s)
- Matthew D M Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA, Australia
| | - Edward Raby
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Frank M Sanfilippo
- Department of Pharmacy, Royal Perth Perth Hospital, Wellington St, Perth, WA, Australia.,School of Population and Global Health, University of Western Australiam, Hackett Drive, Crawley, WA, Australia
| | - Rae Douglass
- Health Support Services, St Georges Terrace, Perth, WA, Australia
| | - Jonathan Chambers
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Duncan McLellan
- Western Diagnostic Pathology, McCoy Road, Myaree, WA, Australia
| | - John R Dyer
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
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