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Evaluation of a multifaceted approach to antimicrobial stewardship education methods for medical residents

Published online by Cambridge University Press:  02 September 2019

Kali M. VanLangen Open the ORCID record for Kali M. VanLangen [Opens in a new window] ,
Lisa E. Dumkow ,
Katie L. Axford ,
Daniel H. Havlichek ,
Jacob J. Baker ,
Ian C. Drobish  and
Andrew P. Jameson
Kali M. VanLangen*
Affiliation:
Departmentof Pharmacy Practice, Ferris State University College of Pharmacy, Grand Rapids, Michigan Department of Pharmacy, Mercy Health Saint Mary’s, Grand Rapids, Michigan
Lisa E. Dumkow
Affiliation:
Department of Pharmacy, Mercy Health Saint Mary’s, Grand Rapids, Michigan
Katie L. Axford
Affiliation:
Departmentof Pharmacy Practice, Ferris State University College of Pharmacy, Grand Rapids, Michigan Department of Pharmacy, Mercy Health Saint Mary’s, Grand Rapids, Michigan
Daniel H. Havlichek
Affiliation:
Michigan State University College of Human Medicine, East Lansing, Michigan
Jacob J. Baker
Affiliation:
Michigan State University College of Human Medicine, East Lansing, Michigan
Ian C. Drobish
Affiliation:
Department of Medicine, University of California, San Diego Health Sciences, San Diego, California
Andrew P. Jameson
Affiliation:
Michigan State University College of Human Medicine, East Lansing, Michigan Department of Infectious Disease, Mercy Health Saint Mary’s, Grand Rapids, Michigan
*
Author for correspondence: Kali M. VanLangen, Department of Pharmacy Practice, Ferris State University College of Pharmacy, 25 Michigan Street Suite 7000, Grand Rapids, MI 49503. E-mail: KaliVanLangen@ferris.edu
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Abstract

Objective:

Medical residents are an important group for antimicrobial stewardship programs (ASPs) to target with interventions aimed at improving antibiotic prescribing. In this study, we compared antimicrobial prescribing practices of 2 academic medical teams receiving different ASP training approaches along with a hospitalist control group.

Design:

Retrospective cohort study comparing guideline-concordant antibiotic prescribing for 3 common infections among a family medicine (FM) resident service, an internal medicine (IM) resident service, and hospitalists.

Setting:

Community teaching hospital.

Participants:

Adult patients admitted between July 1, 2016, and June 30, 2017, with a discharge diagnosis of pneumonia, cellulitis, and urinary tract infections were reviewed.

Methods:

All 3 medical teams received identical baseline ASP education and daily antibiotic prescribing audit with feedback via clinical pharmacists. The FM resident service received an additional layer of targeted ASP intervention that included biweekly stewardship-focused rounds with an ASP physician and clinical pharmacist leadership. Guideline-concordant prescribing was assessed based on the institution’s ASP guidelines.

Results:

Of 1,572 patients, 295 (18.8%) were eligible for inclusion (FM, 96; IM, 69; hospitalist, 130). The percentage of patients receiving guideline-concordant antibiotic selection empirically was similar between groups for all diagnoses (FM, 87.5%; IM, 87%; hospitalist, 83.8%; P = .702). No differences were observed in appropriate definitive antibiotic selection among groups (FM, 92.4%; IM, 89.1%; hospitalist, 89.9%; P = .746). The FM resident service was more likely to prescribe a guideline-concordant duration of therapy across all diagnoses (FM, 74%; IM, 56.5%; hospitalist, 44.6%; P < .001).

Conclusions:

Adding dedicated stewardship-focused rounds into the graduate medical curriculum demonstrated increased guideline adherence specifically to duration of therapy recommendations.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 11 , November 2019 , pp. 1236 - 1241
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: Preliminary data from this study were presented at Grand Rapid Citywide Research Day on April 18, 2018, in Grand Rapids, Michigan.

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