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Maldonado Yanez BV, Ferrara KE, Lueking R, Morrisette T, Brewer EE, Lewis NH, Burgoon R, Mediwala Hornback K, Hamby AC. Comparison of the impact of a system tele-antimicrobial stewardship program on the conversion of intravenous-to-oral antimicrobials in community hospitals. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e159. [PMID: 39371437 PMCID: PMC11450665 DOI: 10.1017/ash.2024.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 10/08/2024]
Abstract
Objectives Evaluate system-wide antimicrobial stewardship program (ASP) update impact on intravenous (IV)-to-oral (PO) antimicrobial conversion in select community hospitals through pre- and postimplementation trend analysis. Methods Retrospective study across seven hospitals: region one (four hospitals, 827 beds) with tele-ASP managed by infectious diseases (ID)-trained pharmacists and region two (three hospitals, 498 beds) without. Data were collected pre- (April 2022-September 2022) and postimplementation (April 2023-September 2023) on nine antimicrobials for the IV to PO days of therapy (DOTs). Antimicrobial administration route and (DOTs)/1,000 patient days were extracted from the electronical medical record (EMR). Primary outcome: reduction in IV DOTs/1,000 patient days. Secondary outcomes: decrease in IV usage via PO:total antimicrobial ratios and cost reduction. Results In region one, IV usage decreased from 461 to 209/1,000 patient days (P = < .001), while PO usage increased from 289 to 412/1,000 patient days (P = < .001). Total antimicrobial use decreased from 750 to 621/1,000 patient days (P = < .001). In region two, IV usage decreased from 300 to 243/1,000 patient days (P = .005), and PO usage rose from 154 to 198/1,000 patient days (P = .031). The PO:total antimicrobial ratios increased in both regions, from .42-.52 to .60-.70 in region one and from .36-.55 to .46-.55 in region two. IV cost savings amounted to $19,359.77 in region one and $4,038.51 in region two. Conclusion The ASP intervention improved IV-to-PO conversion rates in both regions, highlighting the contribution of ID-trained pharmacists in enhancing ASP initiatives in region one and suggesting tele-ASP expansion may be beneficial in resource-constrained settings.
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Affiliation(s)
| | - Kendall E. Ferrara
- Medical University of South Carolina College of Pharmacy, Charleston, SC, USA
| | - Richard Lueking
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Taylor Morrisette
- Department of Pharmacy Services, Medical University of South Carolina Health, Charleston, SC, USA
| | - Erin E. Brewer
- Department of Pharmacy Services, Medical University of South Carolina Florence Medical Center, Florence, SC, USA
| | - Nicole H. Lewis
- Department of Medical Education, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Rachel Burgoon
- Department of Pharmacy Services, Medical University of South Carolina Health, Charleston, SC, USA
| | | | - Aaron C. Hamby
- Department of Pharmacy Services, Medical University of South Carolina Health, Charleston, SC, USA
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Vest TA, Gazda NP, O'Neil DP, Eckel SF. Practice-enhancing publications about the medication-use process in 2021. Am J Health Syst Pharm 2024; 81:e489-e519. [PMID: 38864424 DOI: 10.1093/ajhp/zxae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Indexed: 06/13/2024] Open
Abstract
PURPOSE This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2021 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring, and monitoring/medication reconciliation. Articles evaluating at least one step of the MUP were assessed for their usefulness toward practice improvement. SUMMARY A PubMed search was conducted in January 2022 for articles published in calendar year 2021 using targeted Medical Subject Headings (MeSH) keywords, and searches of the table of contents of selected pharmacy journals were conducted, providing a total of 7,178 articles. A thorough review identified 79 potentially practice-enhancing articles: 15 for prescribing/transcribing, 17 for dispensing, 4 for administration, 21 for monitoring, and 22 for monitoring/medication reconciliation. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of their importance within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing the most impactful publications. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the significant published studies can assist in changing practice at the institutional level.
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Affiliation(s)
- Tyler A Vest
- Duke University Health System, Durham, NC
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | | | | | - Stephen F Eckel
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC
- University of North Carolina Medical Center, Chapel Hill, NC, USA
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Kassamali Escobar Z, Shively NR. Health System and Tele-Antimicrobial Stewardship: The Role of Building Networks. Infect Dis Clin North Am 2023; 37:873-900. [PMID: 37657974 DOI: 10.1016/j.idc.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Tele-antimicrobial stewardship programs (tele-ASPs) use technology and remote access to resources and clinical expertise to expand antimicrobial services within and outside of health systems. Models of tele-ASPs are workforce multiplying and workforce extending, depending on how they are structured. Building rapport and strong interpersonal networks are essential for successful ASPs. The available evidence suggests that an optimal model for tele-ASP includes hands-on involvement from remote infectious disease (ID) expertise with implementation by local pharmacists. However, this model remains limited by the available time and cost of ID-trained specialists.
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Affiliation(s)
- Zahra Kassamali Escobar
- University of Washington Center for Stewardship in Medicine, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 825 Eastlake Avenue, Mail Stop G5-900, P.O. Box 19023, Seattle, WA 98109, USA
| | - Nathan R Shively
- Division of Infectious Diseases, Allegheny Health Network, 320 E North Avenue, Fourth Floor, East Wing, Suite 406, Pittsburgh, PA 15212, USA.
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Dirjayanto VJ, Lazarus G, Geraldine P, Dyson NG, Triastari SK, Anjani JV, Wisnu NK, Sugiharta AJ. Efficacy of telemedicine-based antimicrobial stewardship program to combat antimicrobial resistance: A systematic review and meta-analysis. J Telemed Telecare 2023:1357633X231204919. [PMID: 37847852 DOI: 10.1177/1357633x231204919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a major public health threat. Improving antimicrobial use is the main strategy against AMR, but it is challenging to implement especially in low-resource settings. Thus, this review aims to explore the efficacy of telehealth-based antimicrobial stewardship programs (ASP), which is more accessible. METHODS Registered to PROSPERO and following PRISMA guidelines, literature search was performed in databases including PubMed, Scopus, Cochrane, Science Direct, EBSCOhost, EMBASE, and Google Scholar, searching for studies implementing telehealth ASP. Critical appraisal of studies was performed using Newcastle-Ottawa Scale for Cohort Studies (NOS), Cochrane Risk-of-Bias tool (RoB) 2.0, and Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I). We utilized inverse variance, random effects model to obtain the pooled odds ratio (OR) and mean difference (MD) estimates, as well as sensitivity and subgroup analysis. RESULTS AND DISCUSSION The search yielded 14 studies. Telehealth-based ASP was associated with better adherence to guidelines (pooled OR: 2.78 [95%CI:1.29-5.99], p = 0.009; I2 = 93%), within which streamlining yielded better odds (pooled OR: 30.54 [95%CI:10.42-89.52], p < 0.001) more than the compliance with policy subgroup (pooled OR: 1.60 [95%CI:1.02-2.51], p = 0.04). The odds of antimicrobial prescription rate reduced significantly (pooled OR: 0.60 [95%CI:0.42-0.85], p = 0.005; I2 = 94%), especially for the lower respiratory infection subgroup (pooled OR: 0.37 [95%CI:0.28-0.49], p < 0.001). Days of therapy decreased (pooled MD: -47.12 [95%CI: -85.78- -8.46], p = 0.02; I2 = 100%), with the greatest effect in acute care settings (pooled MD: -97.73 [95%CI:-147.48-47.97], p = 0.0001). Mortality did not change significantly (pooled OR: 1.20 [95%CI:0.69-2.10], p = 0.52; I2 = 63%). CONCLUSION Telehealth-based ASP was proven beneficial to increase adherence to guideline and reduce prescription rates, without significantly affecting patient clinical outcome. After further studies, we recommend more widespread use of telemedicine to combat AMR.
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Affiliation(s)
- Valerie J Dirjayanto
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Faculty of Medicine, Universitas Indonesia, Pondok Cina, Beji, Depok, West Java 16424, Indonesia
| | - Gilbert Lazarus
- Faculty of Medicine, Universitas Indonesia, Pondok Cina, Beji, Depok, West Java 16424, Indonesia
| | - Priscilla Geraldine
- Faculty of Medicine, Universitas Indonesia, Pondok Cina, Beji, Depok, West Java 16424, Indonesia
| | - Nathaniel G Dyson
- Faculty of Medicine, Universitas Indonesia, Pondok Cina, Beji, Depok, West Java 16424, Indonesia
| | - Stella K Triastari
- Faculty of Medicine, Universitas Indonesia, Pondok Cina, Beji, Depok, West Java 16424, Indonesia
| | - Jasmine V Anjani
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Faculty of Medicine, Universitas Indonesia, Pondok Cina, Beji, Depok, West Java 16424, Indonesia
| | - Nayla Kp Wisnu
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Faculty of Medicine, Universitas Indonesia, Pondok Cina, Beji, Depok, West Java 16424, Indonesia
| | - Adrianus J Sugiharta
- Faculty of Medicine, Universitas Indonesia, Pondok Cina, Beji, Depok, West Java 16424, Indonesia
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Lapin JS, Smith RD, Hornback KM, Johnson JK, Claeys KC. From bottle to bedside: Implementation considerations and antimicrobial stewardship considerations for bloodstream infection rapid diagnostic testing. Pharmacotherapy 2023; 43:847-863. [PMID: 37158053 DOI: 10.1002/phar.2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023]
Abstract
Antimicrobial stewardship (AMS) programs have been quick to adopt novel molecular rapid diagnostic technologies (mRDTs) for bloodstream infections (BSIs) to improve antimicrobial management. As such, most of the literature demonstrating the clinical and economic benefits of mRDTs for BSI is in the presence of active AMS intervention. Leveraging mRDTs to improve antimicrobial therapy for BSI is increasingly integral to AMS program activities. This narrative review discusses available and future mRDTs, the relationship between the clinical microbiology laboratory and AMS programs, and practical considerations for optimizing the use of these tools within a health system. Antimicrobial stewardship programs must work closely with their clinical microbiology laboratories to ensure that mRDTs are used to their fullest benefit while remaining cognizant of their limitations. As more mRDT instruments and panels become available and AMS programs continue to expand, future efforts must consider the expansion beyond traditional settings of large academic medical centers and how combinations of tools can further improve patient care.
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Affiliation(s)
- Jonathan S Lapin
- Department of Pharmacy Practice, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Richard D Smith
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Krutika M Hornback
- Department of Pharmacy Practice, Medical University of South Carolina (MUSC) Health, Charleston, South Carolina, USA
| | - J Kristie Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kimberly C Claeys
- Department of Pharmacy Science and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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Cantey JB, Correa CC, Dugi DD, Huff E, Olaya JE, Farner R. Remote Stewardship for Medically Underserved Nurseries: A Stepped-Wedge, Cluster Randomized Study. Pediatrics 2022; 149:e2021055686. [PMID: 35411402 PMCID: PMC9648107 DOI: 10.1542/peds.2021-055686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Antibiotic overuse is associated with adverse neonatal outcomes. Many medically underserved centers lack pediatric antibiotic stewardship program (ASP) support. Telestewardship may mitigate this disparity. Authors of this study aimed to determine the effectiveness and safety of a nursery-specific ASP delivered remotely. METHODS Remote ASP was implemented in 8 medically underserved newborn nurseries using a stepped-wedge, cluster-randomized design over 3 years. This included a 15-month baseline period, a 9-month "step-in" period using random nursery order, and a 12-month postintervention period. The program consisted of education, audit, and feedback; and 24/7 infectious diseases provider-to-provider phone consultation availability. Outcomes included each center's volume of antibiotic use and the proportion of infants exposed to any antibiotics. Safety measures included length of stay, transfer to another facility, sepsis, and mortality. RESULTS During the study period, there were 9277 infants born (4586 preintervention, 4691 postintervention). Infants exposed to antibiotics declined from 6.2% pre-ASP to 4.2% post-ASP (relative risk 0.68 [95% confidence interval, 0.63% to 0.75%]). Total antibiotic use declined from 117 to 84.1 days of therapy per 1000 patient-days (-28% [95% confidence interval -22% to -34%]. No safety signals were observed. Most provider-to-provider consultations were <5 minutes in duration and occurred during normal business hours. CONCLUSIONS The number of infants exposed to antibiotics and total antibiotic use declined in medically underserved nurseries after implementing a remote ASP. No adverse safety events were seen, and the remote ASP time demands were manageable. Remote stewardship may be a safe and effective strategy for optimizing antibiotic use in medically underserved newborn nurseries.
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Affiliation(s)
- Joseph B. Cantey
- Department of Pediatrics, Divisions of Neonatology and
Allergy, Immunology, and Infectious Diseases, University of Texas Health San
Antonio, San Antonio, Texas
| | - Cynthia C. Correa
- Department of Obstetrics and Gynecology, Dimmit Regional
Hospital, Carrizo Springs, Texas
| | - Daniel D. Dugi
- Department of Family Medicine, Cuero Regional Hospital,
Cuero, Texas
| | - Erin Huff
- Department of Obstetrics and Gynecology, Hill Country
Memorial Hospital, Fredericksburg, Texas
| | - Jorge E. Olaya
- Division of Neonatology, Department of Pediatrics,
University of Texas Health San Antonio, San Antonio, Texas
| | - Rachael Farner
- Department of Pediatrics, Divisions of Neonatology and
Allergy, Immunology, and Infectious Diseases, University of Texas Health San
Antonio, San Antonio, Texas
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