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Novel expansion of a well-established antimicrobial stewardship program: Enhancing program efficiency and reach
Published online by Cambridge University Press: 30 August 2022
Abstract
Objective:
To evaluate efficiency and impact of a novel antimicrobial stewardship program (ASP) prospective-audit-with-feedback (PAF) review process using the Cerner Multi-Patient Task List (MPTL).
Design:
Retrospective cohort study.
Setting:
A 367-bed free-standing, pediatric academic medical center.
Methods:
The ASP PAF review process expanded to monitor all systemic and inhaled antibiotics through use of the MPTL on July 23, 2020. Average number of daily ASP reviews, absolute number of monthly interventions, and time to conduct ASP reviews were compared between the preimplementation period and the postimplementation period following expansion. Antibiotic days of therapy (DOT) per 1,000 patient days for overall and select antibiotics were compared between periods. ASP intervention characteristics were assessed.
Results:
Average daily ASP reviews significantly increased following program expansion (9 vs 14 reviews; P < .0001), and the absolute number of ASP interventions each month also increased (34 vs 52 interventions; P ≤ .0001). Time to conduct daily ASP reviews increased in the postimplementation period (1.03 vs 1.32 hours). Overall antibiotic DOT per 1,000 patient days significantly decreased in the postimplementation period (457.9 vs 427.9; P < .0001) as well as utilization of select, narrow-spectrum antibiotics such as ampicillin and clindamycin. Intervention type and antibiotics were similar between periods. The ASP documented 128 “nonantibiotic interventions” in the postimplementation period, including culture and/or susceptibility testing (32.8%), immunizations (25.8%), and additional diagnostic testing (22.7%).
Conclusions:
Implementation of an ASP PAF review process using the MPTL allowed for efficient expansion of a pre-existing ASP and a decrease in overall antibiotic utilization. ASP documentation was enhanced to fully track the impact of the program.
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- Original Article
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- Copyright
- © The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
References
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.CrossRefGoogle Scholar
Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/hospital-core-elements-H.pdf. Published 2019. Accessed April 1, 2022.Google Scholar
Langford, BJ, Brown, KA, Chan, A, Downing, M. High versus low intensity: what is the optimal approach to prospective audit and feedback in an antimicrobial stewardship program? Infect Control Hosp Epidemiol 2019;40:1344–1347.CrossRefGoogle Scholar
Ohashi, K, Matsuoka, T, Shinoda, Y, et al. Clinical outcome of pharmacist-led prospective audit with intervention and feedback after expansion from patients using specific antibiotics to those using whole injectable antibiotics. Eur J Clin Microbiol Infect Dis 2019;38:593–600.CrossRefGoogle ScholarPubMed
Joint Commission of Hospital Accreditation. Approved: new antimicrobial stewardship standard. Jt Comm Perspect 2016;36(7):1, 3, 4, 8.Google Scholar
Centers for Medicare and Medicaid Services (CMS), HHS. Medicare and Medicaid Programs; Regulatory provisions to promote program efficiency, transparency, and burden reduction; Fire safety requirements for certain dialysis facilities; Hospital and critical access hospital (CAH) changes to promote innovation, flexibility, and improvement in patient care. 84 Fed Reg 2019;84:51732–51834.Google Scholar
Doernberg, SB, Abbo, LM, Burdette, SD, et al. Essential resources and strategies for antibiotic stewardship programs in the acute care setting. Clin Infect Dis 2018;67:1168–1174.CrossRefGoogle ScholarPubMed
Newland, JG, Stach, SM, De Lurgio, SA, et al. Impact of a prospective-audit-with-feedback antimicrobial stewardship program at a children’s hospital. J Pediatric Infect Dis Soc 2012;1:179–186.CrossRefGoogle ScholarPubMed
Wirtz, AL, Burns, AN, Lee, BR, et al. Effectiveness and safety of mandatory antimicrobial indications and durations and a pharmacist-driven 48-hour time-out in a pediatric hospital. Am J Health-Syst Pharm 2020;77:614–621.CrossRefGoogle Scholar
Hersh, AL, De Lurgio, SA, Thurm, C, et al. Antimicrobial stewardship programs in freestanding children’s hospitals. Pediatrics 2015;135:33–39.CrossRefGoogle ScholarPubMed
Tribble, AC, Lee, BR, Flett, KB, et al. Appropriateness of antibiotic prescribing in the United States children’s hospitals: a national point-prevalence survey. Clin Infect Dis 2020;71:226–234.CrossRefGoogle ScholarPubMed
MacBrayne, CE, Williams, MC, Poole, NM, Pearce, K, Cotter, JM, Parker, SK. Inpatient treatment of acute otitis media at a pediatric hospital: a missed teaching opportunity for antimicrobial stewardship. Hosp Pediatr 2020;10:615–619.CrossRefGoogle Scholar
Same, RG, Amoah, J, Hsu, AJ, et al. The association of antibiotic duration with successful treatment of community-acquired pneumonia in children. J Pediatric Infect Dis 2021;10:267–273.CrossRefGoogle ScholarPubMed
Lee, BR, Tribble, AC, Gerber, JS, Hersh, AL, Kronman, MP, Newland, JG. Inappropriate antibiotic surgical prophylaxis in pediatric patients: a national point-prevalence survey. Infect Control Hosp Epidemiol 2020;41:477–479.CrossRefGoogle Scholar
Same, RG, Hsu, AJ, Cosgrove, SE, et al. Antibiotic-associated adverse events in hospitalized children. J Pediatric Infect Dis 2021;10:622–628.CrossRefGoogle ScholarPubMed
El Feghaly, RE, Monsees, EA, Burns, A, et al. Outpatient antimicrobial stewardship programs in pediatrics institutions in 2020: status, needs, barriers. Infect Control Hosp Epidemiol 2021. doi: 10.1017/ice.2021.416.Google Scholar
Wirtz, AL, Monsees, EA, Gibbs, KA, et al. Integration of a lean daily management system into an antimicrobial stewardship program. Pediatr Qual Saf 2021;6:e384.CrossRefGoogle ScholarPubMed
Kapadia, SN, Abramson, EL, Carter, EJ, et al. The expanding role of antimicrobial stewardship programs in hospitals in the United States: lessons learned from a multisite qualitative study. Jt Comm J Qual Patient Saf 2018;44:68–74.Google ScholarPubMed
MacVane, SH, Hurst, JM, Steed, LL. The role of antimicrobial stewardship in the clinical microbiology laboratory: stepping up to the plate. Open Forum Infect Dis 2016;3(4):ofw201.CrossRefGoogle Scholar
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