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Sarker K, Vanstone JR, Adigun O, Boutilier B, Comeau J, Degelman ML, Gottselig P, Berry WE, Milne A, Van Vliet P, Harding SR. Development, implementation and impact of an immunoglobulin stewardship programme in Saskatchewan, Canada. Vox Sang 2024; 119:335-343. [PMID: 38229560 DOI: 10.1111/vox.13593] [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: 09/12/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND AND OBJECTIVES Intravenous immunoglobulin (IVIG) is one of the most costly and limited-supply blood products. Judicious use of this therapy is important to ensure a continued supply is available for patients in need. The Saskatchewan IG Stewardship Program was initiated to monitor and reduce inappropriate IG use. MATERIALS AND METHODS The Program was developed and implemented through the collaborative efforts of a multidisciplinary, inter-organizational team. Funding was provided from provincial organizations to create new positions within the Program and to support stakeholder engagement throughout the process of implementation. Data were collected from local and national databases regarding the amount of IVIG used and appropriateness of orders based on published criteria. RESULTS Over 20 months, the Program helped to reduce unnecessary IVIG use from pre-intervention levels by more than 20%. Interventions from nurse navigators alone reduced inappropriate IVIG use by 2.6%. During the 20-month period following Program initiation, more than 4 million CAD less was spent on IVIG compared with the previous 20 months. CONCLUSION The Saskatchewan IG Stewardship Program has led to more appropriate IVIG use across the province, more effective preservation of this limited healthcare resource, and cost savings that more than cover the cost of administering the Program.
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Affiliation(s)
- Kinsuk Sarker
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Jason R Vanstone
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Oluwaferanmi Adigun
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Brad Boutilier
- Strategy and Innovation, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Jessica Comeau
- Transfusion Safety/Patient Blood Management, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Michelle L Degelman
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Paul Gottselig
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Warren E Berry
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Ardyth Milne
- Rheumatology Consultant, Internal Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Paula Van Vliet
- Transfusion Safety/Patient Blood Management, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Sheila Rutledge Harding
- Transfusion Medicine Consultant, Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
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Martinez-Sobalvarro JV, Júnior AAP, Pereira LB, Baldoni AO, Ceron CS, Dos Reis TM. Antimicrobial stewardship for surgical antibiotic prophylaxis and surgical site infections: a systematic review. Int J Clin Pharm 2021; 44:301-319. [PMID: 34843035 DOI: 10.1007/s11096-021-01358-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/16/2021] [Indexed: 12/26/2022]
Abstract
Background Surgical site infections account for 14-17% of all healthcare-associated infections. Antimicrobial stewardship (AMS) are complementary strategies developed to optimize the use of antimicrobials. Aim to evaluate the effectiveness of AMS in promoting adherence to surgical antibiotic prophylaxis protocols in hospitalized patients, reducing surgical site infection rate and cost-benefit ratio. Method This systematic review of randomized clinical trials, non-randomized clinical trials and before and after studies was performed using Pubmed, Cochrane, Web of Science, Scopus, Embase, Google Scholar and ClinicalTrials.gov, in addition to reference lists of included studies. The risk of bias of studies was measured by the ROBINS-I checklist and the quality of the evidence synthesis by GRADE. Results Fourteen before and after design studies were included. In 85.7% of the studies, AMS was effective in increasing adherence to surgical antibiotic prophylaxis protocols and in 28.5%, there was reduction in surgical site infection rate. Three studies evaluated cost-benefit ratio and found a favorable impact. Eight (57%) studies were at risk of moderate bias and six had severe bias. The evaluation of the synthesis of evidence showed quality ranging from low to very low. Conclusion AMS, such as audit, feedback, education, implementation of a protocol, and a computer-assisted decision support methodology, appear to be effective in promoting adherence to surgical antibiotic prophylaxis protocols, reducing surgical site infection rate with a positive economic impact. However, more studies, particularly randomized clinical trials, are needed to improve the level of evidence of available information on AMS in order to favor decision-making.
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Affiliation(s)
| | | | - Lucas Borges Pereira
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | | | - Carla Speroni Ceron
- Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Tiago Marques Dos Reis
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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Yuan X, Chen K, Zhao W, Hu S, Yu F, Diao X, Chen X, Hu S. Open-label, single-centre, cluster-randomised controlled trial to Evaluate the Potential Impact of Computerisedantimicrobial stewardship (EPIC) on the antimicrobial use after cardiovascular surgeries: EPIC trial study original protocol. BMJ Open 2020; 10:e039717. [PMID: 33243799 PMCID: PMC7692825 DOI: 10.1136/bmjopen-2020-039717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Inappropriate antimicrobial use increases the prevalence of antimicrobial-resistant bacteria. Surgeons are reluctant to implement recommendations of guidelines in clinical practice. Antimicrobial stewardship (AMS) is effective in antimicrobial management, but it remains labour intensive. The computerised decision support system (CDSS) has been identified as an effective way to enable key elements of AMS in clinical settings. However, insufficient evidence is available to evaluate the efficacy of computerised AMS in surgical settings. METHODS AND ANALYSIS The Evaluate of the Potential Impact of Computerised AMS trial is an open-label, single-centre, two-arm, cluster-randomised, controlled trial, which aims to determine whether a multicomponent CDSS intervention reduces overall antimicrobial use after cardiovascular surgeries compared with usual clinical care in a specialty hospital with a big volume of cardiovascular surgeries. Eighteen cardiovascular surgical teams will be randomised 1:1 to either the intervention or the control arm. The intervention will consist of (1) re-evaluation alerts and decision support for the duration of antimicrobial treatment decision, (2) re-evaluation alerts and decision support for the choice of antimicrobial, (3) quality control audit and feedback. The primary outcome will be the overall systemic antimicrobial use measured in days of therapy (DOT) per admission and DOT per 1000 patient-days over the whole intervention period (6 months). Secondary outcomes include a series of indices to evaluate antimicrobial use, microbial resistance, perioperative infection outcomes, patient safety, resource consumption, and user compliance and satisfaction. ETHICS AND DISSEMINATION The Ethics Committee in Fuwai Hospital approved this study (2020-1329). The results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04328090.
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Affiliation(s)
- Xin Yuan
- State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Kai Chen
- State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- Information Centre, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shuang Hu
- National Clinical Research Centre of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Yu
- Information Centre, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaolin Diao
- Information Centre, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xingwei Chen
- Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Lazar HL. Surgical site infections after coronary artery bypass grafting-Does "never" really mean "never"? J Thorac Cardiovasc Surg 2018; 155:1563-1564. [PMID: 29370911 DOI: 10.1016/j.jtcvs.2017.12.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, The Boston University School of Medicine, Boston, Mass.
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Rocchio MA, Schurr JW, Hussey AP, Szumita PM. Intravenous Immune Globulin Stewardship Program at a Tertiary Academic Medical Center. Ann Pharmacother 2016; 51:135-139. [DOI: 10.1177/1060028016673071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: In October 2010, a pharmacist-driven stewardship program was implemented at the Brigham and Women’s Hospital to ensure continued adherence to the prescribing guideline, focusing on indications for intravenous immune globulin (IVIG) use and dosing per ideal body weight. Objective: The primary objective was to describe an IVIG stewardship program at a tertiary academic medical center. Methods: This was a prospective, observational study from January 2013 through December 2014. All patients ordered to receive IVIG during the defined study period were included. The intervention assessed describes a pharmacist-driven IVIG stewardship program for medication approval. The primary end point was guideline compliance based on indication, dose, dosing weight, and frequency. Secondary end points included the number of patients receiving IVIG, indications, orders discontinued as a result of guideline nonadherence, and total amount dispensed. Results: A total of 418 patients were identified during the study time frame. The top indications were: hypogammaglobulinemia in bone marrow transplantation and hematological malignancy (50.7%), acute solid organ rejection (11.8%), and immune thrombocytopenia with bleeding (10.1%). In all, 12 patients (2.9%) received IVIG for an indication nonadherent with the IVIG prescribing guideline; 9 patients (2.2%) and 2 patients (0.5%), respectively, received a different dose or frequency per the prescribed indication; and 12 orders (2.9%) for indications nonadherent to the guideline were discontinued. A total of 26 033 g of IVIG were dispensed during the study period. Conclusions: An IVIG stewardship program, including an institution-specific prescribing guideline and a pharmacist-driven stewardship program, may ensure guideline compliance for appropriateness of indication and dose at an academic medical center.
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