scholarly journals Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study

2018 ◽  
Vol 84 (4) ◽  
pp. 708-715 ◽  
Author(s):  
Maher R. Khdour ◽  
Hussein O. Hallak ◽  
Mamoon A. Aldeyab ◽  
Mowaffaq A. Nasif ◽  
Aliaa M. Khalili ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Hospitalized Patients ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Prospective Audit And Feedback

scholarly journals Targeted Outpatient Fluoroquinolone Intervention utilizing an Integrated Electronic Health Record in the Bureau of Prisons

2020 ◽  
Vol 41 (S1) ◽  
pp. s402-s402
Author(s):  
Deborah Long ◽  
Alisha Edmunds ◽  
Tyler Campbell ◽  
Michael Long
Keyword(s):  
Electronic Health Record ◽  
Antimicrobial Stewardship ◽  
Singular System ◽  
Audit And Feedback ◽  
Health Record ◽  
Prospective Audit ◽  
Short Period ◽  
Electronic Health ◽  
Prospective Audit And Feedback ◽  
Bureau Of Prisons

Background: Fluoroquinolones are the perfect target for antimicrobial stewardship programs (ASPs) due to their broad-spectrum nature, poor safety profile, and frequent misuse. In April 2019, the Bureau of Prisons (BOP) created a national antimicrobial stewardship clinical pharmacist consultant program. One of the program’s main initiatives was to screen active fluoroquinolone prescriptions for appropriateness and work with providers to tailor therapy as needed. Since July 2019, pharmacist consultants have utilized a singular system-wide electronic health record (EHR) to conduct fluoroquinolone prospective audit and feedback targeting all BOP sites across the country. The objective was to assess the national impact of prospective audit and feedback on outpatient fluoroquinolone prescriptions utilizing pharmacist consultants and an integrated EHR. Method: Reviews were conducted in a federal correctional setting including 122 BOP sites with an average daily population of 167,308 inmates. The ASP consisted of 7 pharmacists, each assigned a region across the country. Consultant pharmacists were in charge of conducting daily fluoroquinolone reviews within 72 hours of the prescription being written, utilizing a singular system-wide EHR to gain remote access to newly prescribed prescriptions along with all other pertinent information (ie, clinical notes, patient profiles, laboratory, and radiology). Interventions were sent via e-mail. Total fluoroquinolone prescriptions per 1,000 inmates during the preintervention period (July 1, 2018, to September 30, 2018) were compared to the postintervention period (July 1, 2019, to September 30, 2019), after the development of the clinical consultant program. Data were also collected during the 3-month postintervention period to include total fluoroquinolone prescriptions reviewed, total recommendations sent, percentage of recommendations accepted, and intervention types. Results: In total, 833 fluoroquinolone prescriptions of 1, 264 total prescriptions written (66%)were reviewed over the 3-month postintervention period. In total,192 interventions were recommended (23%). Of the interventions recommended, 65 (34%) were accepted. The most common intervention was to stop therapy (41%), followed by changing antibiotic (37%), and shorten therapy duration (8%). Total outpatient fluoroquinolone prescriptions decreased by 1.5 prescriptions per 1,000 patients after the intervention. Conclusions: Pharmacist-driven prospective audit and feedback on a national scale utilizing a singular system-wide EHR resulted in an overall decrease in outpatient fluoroquinolone prescriptions over short period of time.Funding: NoneDisclosures: None

Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

2018 ◽  
Vol 39 (8) ◽  
pp. 941-946 ◽  
Author(s):  
Bradley J. Langford ◽  
Julie Hui-Chih Wu ◽  
Kevin A. Brown ◽  
Xuesong Wang ◽  
Valerie Leung ◽  
...  
Keyword(s):  
Observational Study ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Defined Daily Doses ◽  
Prospective Audit And Feedback ◽  
The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

scholarly journals 228. Impact of Early Alert to Antimicrobial Stewardship Interventions with the Prospective Audit and Feedback Strategy

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S98-S98
Author(s):  
Sarah Si Lin Tang ◽  
Lun Yi Tan ◽  
Daphne Yah Chieh Yii ◽  
Andrea L Kwa ◽  
Piotr Chlebicki
Keyword(s):  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Feedback Strategy ◽  
Prospective Audit And Feedback ◽  
Early Alert

Antibiotic stewardship in the intensive care unit: Challenges and opportunities

2019 ◽  
Vol 40 (6) ◽  
pp. 693-698 ◽  
Author(s):  
Kathleen Chiotos ◽  
Pranita D. Tamma ◽  
Jeffrey S. Gerber
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Stewardship ◽  
Audit And Feedback ◽  
Molecular Diagnostic ◽  
Future Research ◽  
Antibiotic Overuse ◽  
Challenges And Opportunities ◽  
Prospective Audit And Feedback ◽  
The Impact

AbstractInfections due to antibiotic-resistant organisms are increasing in prevalence and represent a major public health threat. Antibiotic overuse is a major driver of this epidemic, and antibiotic stewardship an important means of limiting antibiotic resistance. The intensive care unit (ICU) setting presents an intersection of opportunities and challenges for effective antibiotic stewardship, but limited data inform optimal stewardship interventions in this setting. In this review, we present unique considerations for stewardship interventions the ICU setting and summarize available data evaluating the impact of prospective audit and feedback, diagnostic test stewardship, rapid molecular diagnostic tests, and procalcitonin-guided algorithms for antibiotic discontinuation. The existing knowledge gaps ripe for future research are emphasized.

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