scholarly journals Effect of Communication Errors During Calls to an Antimicrobial Stewardship Program

2007 ◽  
Vol 28 (12) ◽  
pp. 1374-1381 ◽  
Author(s):  
Darren R. Linkin ◽  
Neil O. Fishman ◽  
J. Richard Landis ◽  
Todd D. Barton ◽  
Steven Gluckman ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Records ◽  
Academic Medical Center ◽  
Patient Data ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Prior Approval ◽  
Increased Risk ◽  
Telephone Calls ◽  
Microbiological Data

Objective.To determine how inaccurate communication of patient data by clinicians in telephone calls to the prior-approval antimicrobial stewardship program (ASP) staff affects the incidence of inappropriate antimicrobial recommendations made by ASP practitioners.Design.A retrospective cohort design was used. The accuracy of the patient data communicated was evaluated against patients' medical records to identify predetermined, clinically significant inaccuracies. Inappropriate antimicrobial recommendations were defined having been made if an expert panel unanimously rated the actual recommendations as inappropriate after reviewing vignettes derived from inpatients' medical records.Setting.The setting was an academic medical center with a prior-approval ASP.Patients.All inpatient subjects of ASP prior-approval calls were eligible for inclusion.Results.Of 200 ASP telephone calls, the panel agreed about whether or not antimicrobial recommendations were inappropriate for 163 calls (82%); these 163 calls were then used as the basis for further analyses. After controlling for confbunders, inaccurate communication was found to be associated with inappropriate antimicrobial recommendations (odds ratio [OR], of 2.2; P = .03). In secondary analyses of specific data types, only inaccuracies in microbiological data were associated with the study outcome (OR, 7.5; P = .002). The most common reason panelists gave for rating a recommendation as inappropriate was that antimicrobial therapy was not indicated.Conclusions.Inaccurate communication of patient data, particularly microbiological data, during prior-approval calls is associated with an increased risk of inappropriate antimicrobial recommendations from the ASP. Clinicians and ASP practitioners should work to confirm that critical data has been communicated accurately prior to use of that data in prescribing decisions.

scholarly journals Inaccurate Communications in Telephone Calls to an Antimicrobial Stewardship Program

2006 ◽  
Vol 27 (7) ◽  
pp. 688-694 ◽  
Author(s):  
Darren R. Linkin ◽  
Sarah Paris ◽  
Neil O. Fishman ◽  
Joshua P. Metlay ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Antimicrobial Stewardship ◽  
Odds Ratio ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Patient Data ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Prior Approval ◽  
Telephone Calls

Background.Antimicrobial stewardship programs (ASPs) decrease unnecessary antimicrobial use, decrease antimicrobial resistance, and improve patient outcomes. The effectiveness of a prior approval system—that is, the requirement that approval be obtained from ASP practitioners before certain antimicrobials can be used—depends on the accuracy of the patient data communicated from the primary service.Objectives.To determine the incidence of inaccurate communication of patient data during ASP interactions, describe examples of inaccurate communications, and identify risk factors for inaccurate communication.Design.We used a retrospective cohort design. We evaluated the communicated patient data for clinically important inaccuracies, using the patients' medical records as the gold standard.Setting.A tertiary care medical center that has a prior approval system for restricted antimicrobials.Patients.Inpatients discussed in telephone ASP interactions.Intervention.Observational study.Results.Of telephone calls requesting prior approval from ASP practitioners, 39% (95% confidence interval [CI], 31%-48%) contained an inaccuracy in at least 1 type of patient data (eg, current antimicrobial therapy); the incidence varied widely between data types. Examples of inaccuracies are given to demonstrate their clinical relevance. In multivariable analysis, inaccurate communications were more common for telephone calls from surgical services (versus calls from nonsurgical services: odds ratio, 2.1 [95% CI, 1.1-3.9]) and for calls received by Infectious Diseases fellows (versus pharmacists: odds ratio, 2.0 [95% CI, 1.1-3.8]).Conclusions.A high proportion of ASP calls requesting prior approval included patient data inaccuracies, which have the potential to affect the prescribing of antimicrobials. Although risk factors were identified, these communication errors were common across the different types of ASP interactions. Inaccurate communications may compromise the utility of ASPs that use a prior approval system for optimizing antimicrobial use.

scholarly journals 1064. Antimicrobial Stewardship Program at a Large Academic Medical Center, Impact Over 12 Years

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S376-S377
Author(s):  
Susan E Kline ◽  
Kimberly Boeser ◽  
Jeana Houseman ◽  
Samantha Saunders ◽  
Shawnda Johnson ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Downward Trend ◽  
Full Time ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Hospital Acquired

Abstract Background The University of Minnesota Medical Center (UMMC) is a tertiary care facility, which has had a comprehensive antimicrobial stewardship program (ASP) for 12 years. Methods The antimicrobial stewardship team is comprised of a full-time PharmD and ID staff physicians. Recommendations are placed in the electronic medical record as a progress note. Verbal recommendations may also be made. Results There was a downward trend in Hospital-acquired (HA) C. difficile diarrhea from 2007 to 2014 from 1.2 to 0.5/1000 patient-days (pt day). Rates appear stable from 2014 to 2019 with adjustment for change to NHSN lab-based CDI surveillance (Figure 1). From 2009 to 2019 a decrease was seen in VRE hospital-acquired infections (HAI) from 0.53 to 0.21/1,000 patient-days and in MRSA HAIs from 0.2 to 0.14/1,000 patient-days. Newly acquired ESBL HAIs have remained relatively stable from 2009 to 2019 at 0.09 to 0.05/1,000 patient-days. CRE HAIs are low but stable rates at 0.02/1,000 patient-days (Figure 2). We track antimicrobial utilization for internal and national reporting (starting in July 2017). A SAAR for all Antibacterial agents (ICUs, wards, and oncology units) of 1.33 in 2018. Our top four agents average DOT; piperacillin/tazobactam (66.81), cefepime (34.40), oral levofloxacin (23.56) and intravenous meropenem (21.49). We demonstrate lower average DOT for our restricted antimicrobials (206.21) as compared with our nonrestricted antimicrobials (236.74) (Figure 3). Cost savings continued from year to year. After adjusting for inflation annually, our expected costs ($84.08) compared with actual costs ($40.12 ytd 2019), demonstrates effective cost management of antimicrobial agents. (Figure 4) Conclusion We observed a decrease in HAIs VRE and C. difficile infections after 3 years of operation, and MRSA after 5 years. This downward trend has continued. ESBL HAIs remain relatively stable and CRE are stable at low rates but remain emerging HAIs of concern. We are now focusing efforts on limiting unneeded fluoroquinolone and carbapenem use. We continue to analyze our SAAR data and internal DOT data to identify areas of opportunity to improve antimicrobial use. The ASP outcomes have continued to cost justify ongoing efforts. The effects of the program and the Infection Prevention Department appear to be synergistic. Disclosures All authors: No reported disclosures.

scholarly journals 1029. Clinical and economic outcomes of a newly implemented daptomycin dosing policy in a four-hospital health system

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S362-S362
Author(s):  
Meredith Todd ◽  
Kelci Jones ◽  
Sharon Hill
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Pharmacokinetic Data ◽  
Antimicrobial Stewardship Program ◽  
Obese Patients ◽  
Pharmacy Department ◽  
Stewardship Program ◽  
Increased Risk ◽  
Dosing Strategy ◽  
Drug Waste

Abstract Background In light of recently published clinical and pharmacokinetic data regarding the use of daptomycin in obese patients, the Charleston Area Medical Center (CAMC) Antimicrobial Stewardship Program implemented an adjusted body weight dosing strategy for obese patients. Along with this new dosing strategy, an effort to reduce drug waste was also implemented by restricting the timing of routinely scheduled daptomycin doses for inpatients. This study aims to determine the clinical outcomes for patients receiving daptomycin both before and after this policy change. Secondary objectives include assessing creatinine phosphokinase (CK) levels in the study participants, defining the risk of CK elevation with the coadministration of HMG Co-A reductase inhibitors and daptomycin, and assessing any reduction in drug waste for the pharmacy department. Methods This study is a single-center, one-group pretest-posttest, quasi-experimental study evaluating the implementation of a two-part daptomycin dosing policy. The pretest group included all patients meeting inclusion and exclusion criteria that received daptomycin at CAMC from September 1 - November 30, 2017. The new daptomycin dosing policy was implemented on September 1, 2018. The posttest group included all patients meeting the stated criteria that received daptomycin from September 1 - November 30, 2018. Results A total of 118 patients were included in this study. There were 5 (7.7%) treatment failures in the pretest group and 3 (5.7%) in the posttest group (P = 0.7). Of the patients with CK levels monitored, 6 (33%) were found to have significant elevations in the pretest group and 4 (40%) were found in the posttest group (P = 0.6). There was no difference observed in the risk of CK elevation with daptomycin administration in the presence of an HMG-CoA reductase inhibitor. For the two time periods reviewed, the pharmacy department purchased fewer vials of daptomycin in the posttest group. Conclusion Patients at CAMC receiving daptomycin after implementation of a new dosing policy did not experience an increased risk of treatment failure. The Antimicrobial Stewardship Program will continue to monitor patients receiving daptomycin therapy at CAMC. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of the Impact of Antimicrobial Stewardship Program (ASP) on Unrestricted Use of Meropenem at an Academic Medical Center

2019 ◽  
Vol 66 (1) ◽  
pp. 29-33
Author(s):  
Priyam Mithawala ◽  
Edo-abasi McGee
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Antibiotic Use ◽  
Control Group ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Significant Difference ◽  
The Impact

Objective The primary objectives were to evaluate the prescriber acceptance rate of Antimicrobial Stewardship Program (ASP) pharmacist recommendation to de-escalate/discontinue meropenem, and estimate the difference in duration of meropenem therapy. The secondary objective was to determine incidence of adverse events in the two groups. Methods It was a retrospective study. All patients admitted to Gwinnett Medical Center and receiving meropenem from January–November 2015 were included in the study. Exclusion criteria were: patients admitted to intensive care unit, one-time dose, infectious disease consultation, and age <18 years. Electronic medical records were reviewed for data collection. The control group consisted of patients from January–July 2015 when there was no ASP pharmacist. The intervention group consisted of patients from August–November 2015 during which period the ASP pharmacist recommended de-escalation/discontinuation of meropenem based on culture and sensitivity results. Results A total of 41 patients were studied, 21 in the control group and 20 in the intervention group. There was no significant difference in baseline characteristics in the two groups and in terms of prior hospitalization or antibiotic use (within 90 days) and documented or suspected MDRO infection at the time of admission. De-escalation/discontinuation was suggested in 16/20 patients in the intervention group (80%), and intervention was accepted in 68%. The mean duration of therapy was significantly decreased in the intervention group (5.6 days vs. 8.1 days, p =0.0175). Two patients had thrombocytopenia (unrelated to meropenem), and none of the patients had seizure. Conclusion Targeted antibiotic review is an effective ASP strategy, which significantly decreases the duration of meropenem therapy.

scholarly journals India Antimicrobial Stewardship and Resistance (INTEREST): A Needs Assessment Survey

2020 ◽  
Vol 41 (S1) ◽  
pp. s297-s298
Author(s):  
Aditya Shah ◽  
John OHoro ◽  
Varun Shah ◽  
Taru Dutt ◽  
Sanjiv Shah ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Antimicrobial Stewardship ◽  
Medical Records ◽  
Online Survey ◽  
Data Access ◽  
Diagnostic Techniques ◽  
Easy Access ◽  
Hospital Inpatient ◽  
Stewardship Program ◽  
Microbiological Data

Background: The emergence and spread of antimicrobial resistance is a major problem in India with significant knowledge on whether this is a systems–based, prescriber and patient characteristic based or diagnostic technologies–based issue. Methods: An electronic survey was sent to select distribution list of intensive care units (ICU) and hospital inpatient (medicine ward) providers from India. Survey questions included antimicrobial clinical practice data, access to electronic medical records, microbiological diagnostic techniques, and access to microbiology data. The survey focused on antimicrobial prescription trends and their association with diagnostic techniques. Results: There were 90 responses from 18 states in 65 ZIP codes. They had median of 187.5 beds (IQR, 40–470). Representative responders had a median age of 40 years (IQR, 31–53). Among the responders, 73 (81%) were men. Of the 90 responses, 48 providers (52%) practiced solely in ICUs (medical and surgical) and 40 providers (45%) practiced solely on the medical ward or floor, with the rest practicing in other units. In total, 31 centers (34%) reported full access to electronic medical records, and 53 centers (59%) had access to wi-fi or Internet. Interestingly, 27 centers (30%) needed to use personal provider phone data for Internet access. Only 26 centers (29%) had electronic microbiological data. Also, 63 respondents (70%) agreed to de-escalation behavior after receiving microbiological data. In addition, 55 respondents (61%) agreed that patients have easy access to outpatient antibiotics without an appropriate prescription, over the counter. Furthermore, 58 responders (64%) said that antibiotic resistance was a major problem at their center, and 61 responders (68%) were familiar with antimicrobial stewardship programs. Among the centers, 69 (77%) had no access to formal infectious disease programs at their center. Only 27 centers (30%) had a formal Clostridium difficile–associated infection reporting and control program. Only 28 centers (31%) had a formal occupational health program. Conclusions: In a large-scale, semistructured, online survey, most issues related to easy availability of antibiotics and lack of “electronization” of medical and microbiological records. It was reassuring that most providers expressed knowledge of the existing antimicrobial stewardship program.Funding: NoneDisclosures: None

Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

2012 ◽  
Vol 33 (4) ◽  
pp. 338-345 ◽  
Author(s):  
Harold C. Standiford ◽  
Shannon Chan ◽  
Megan Tripoli ◽  
Elizabeth Weekes ◽  
Graeme N. Forrest
Keyword(s):  
Infectious Diseases ◽  
Cost Analysis ◽  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Fiscal Year ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Large Tertiary Care

Background.An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.Design.A descriptive cost analysis before, during, and after the program.Patients/Setting.A large tertiary care teaching medical center.Methods.Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.Results.The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.Conclusions.The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

scholarly journals Evaluation of Antimicrobial Therapy Orders Circumventing an Antimicrobial Stewardship Program: Investigating the Strategy of “Stealth Dosing”

2007 ◽  
Vol 28 (05) ◽  
pp. 551-556 ◽  
Author(s):  
Lori Ann LaRosa ◽  
Neil O. Fishman ◽  
Ebbing Lautenbach ◽  
Ross J. Koppel ◽  
Knashawn H. Morales ◽  
...  
Keyword(s):  
Study Design ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Stewardship Program ◽  
Prior Approval

Objective. Prior-approval antimicrobial stewardship programs (ASPs) improve patient outcomes and decrease antimicrobial resistance. These benefits would be limited if physicians circumvented ASP efforts. We evaluated whether prescribers wait until after the prior-approval period to order restricted antimicrobial therapy that is in conflict with guidelines or unnecessary. Design. A cross-sectional study design and a retrospective cohort study design. Setting. A tertiary care, academic medical center with a prior-approval ASP that was active between 8 AM and 10 PM. Methods. We evaluated whether there was an increase in the proportion of orders for antimicrobial therapy that involve restricted (vs nonrestricted) antimicrobials during the first hour that the ASP is inactive (ie, the first hour that prior approval is not required), compared with the remainder of the day. We also evaluated whether restricted antimicrobial therapy ordered during this first hour is less likely to be continued when the ASP becomes active the next day, compared with that ordered during the preceding hour. Results. A greater proportion of the antimicrobial therapy orders placed between 10:00 PM and 10:59 PM were for restricted agents, compared with orders placed during other periods (57.0% vs 49.9%; P = .02). Surgical patients for whom antimicrobial therapy orders were placed between 10:00 PM and 10:59 PM were less likely to have that antimicrobial therapy continued, compared with patients whose therapy was ordered between 9:00 PM and 9:59 PM (60.0% vs 98.1%; P &lt;.001). Nonsurgical patients whose therapy orders were placed between 10:00PM and 10:59 PM were also less likely to have the ordered antimicrobial therapy continued, compared with patients whose therapy was ordered between 9:00 PM and 9:59 PM (70.8% vs 84.2%; P = .01). Conclusion. Physicians avoid having to obtain prior approval for therapy involving restricted antimicrobials by waiting until restrictions are no longer active to place orders. Compared with restricted antimicrobial therapy ordered when the ASP is active, these courses of therapy are less often continued by the ASP, suggesting that they are more likely to be in conflict with guidelines or unnecessary.

scholarly journals Impact of an Antimicrobial Stewardship Program at a Large Academic Medical Center, a Decade of Experience

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S264-S265
Author(s):  
Susan Kline ◽  
Kimberly Boeser ◽  
Samantha Saunders ◽  
Kari Gand ◽  
Jeana Houseman ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Academic Medical
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