scholarly journals User-Centered Design in Pediatric Acute Care Settings Antimicrobial Stewardship

2021 ◽  
Vol 12 (01) ◽  
pp. 034-040
Author(s):  
Michael J. Ward ◽  
Bryson Chavis ◽  
Ritu Banerjee ◽  
Sophie Katz ◽  
Shilo Anders
Keyword(s):  
Ambulatory Care ◽  
Antimicrobial Stewardship ◽  
Information Needs ◽  
Tertiary Care ◽  
Urgent Care ◽  
Future Research ◽  
Antibiotic Prescribing ◽  
Feedback Report ◽  
User Centered Design ◽  
Core Element

Abstract Background Antibiotic prescribing in ambulatory care centers is increasing. Previous research suggests that 20 to 50% of antibiotic prescriptions are either unnecessary or inappropriate. Unnecessary antibiotic consumption can harm patients by increasing antibiotic resistance and drug-associated toxicities, and the reasons for such use are multifactorial. Antimicrobial Stewardship Programs (ASP) were developed to guide better use of antibiotics. A core element of ASP is to provide feedback to clinical providers. To create clinically meaningful feedback, user-center design (UCD) is a robust approach to include end-users in the design process to improve systems. Objective The study aimed to take a UCD approach to developing antibiotic prescribing feedback through input from clinicians in two ambulatory care settings. Methods We conducted two group prototyping sessions with pediatric clinicians who practice in the emergency department and urgent care settings at a tertiary care children's hospital. Participants received background on the problem of antibiotic prescribing and then were interviewed about their information needs, perceived value, and desired incentives for a prescribing feedback system. Sessions concluded with their response and recommendations to sample sections of an antibiotic feedback report including orienting material, report detail, targeted education, and resources. Results A UCD approach was found to be highly valuable in the development of a feedback mechanism that is viewed as desirable by clinicians. Clinicians preferred interpreting the data themselves with aids such as diagrams and charts over the researcher concluded statements about the clinician's behavior. Specific feedback that clinicians considered redundant were removed from the model if preexisting alerts were established. Conclusion Integrating a UCD approach in developing ASP feedback identified desirable report characteristics that substantially modified preliminary wireframes for feedback. Future research will evaluate the clinical effectiveness of our feedback reports in outpatient settings.

scholarly journals 142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Travis B Nielsen ◽  
Maressa Santarossa ◽  
Beatrice D Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

scholarly journals 1840. Development of an Innovative Antibiotic Prescribing Dashboard to Enhance Antimicrobial Stewardship in the Ambulatory Care Setting

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S525-S525
Author(s):  
Erin Gentry ◽  
Sarah Davis ◽  
Cliff Collins ◽  
Mansi Dubey ◽  
Chloe Sweeney ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Antimicrobial Stewardship ◽  
Care Setting ◽  
Antibiotic Prescribing ◽  
Ambulatory Care Setting

scholarly journals 1122. Implementation of an Outpatient Antimicrobial Stewardship Program within a Pediatric Health System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S398-S399
Author(s):  
Alaina Burns ◽  
Brian R Lee ◽  
Jennifer Goldman ◽  
Angela Myers ◽  
Angela Myers ◽  
...  
Keyword(s):  
Otitis Media ◽  
Antimicrobial Stewardship ◽  
Safety Net ◽  
Baseline Data ◽  
Prescribing Patterns ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Targeted Interventions ◽  
Core Elements ◽  
Tract Infections

Abstract Background Over 60% of antibiotic expenditures occur in outpatient settings with at least 30% being unnecessary. In 2016, the Centers for Disease Control and Prevention (CDC) defined core elements for outpatient antimicrobial stewardship programs (ASP): commitment from all members of the healthcare team, action for policy and practice, tracking and reporting, and education and expertise. Quantifying local prescribing practices and frontline provider engagement are essential for successful outpatient ASP. We describe our outpatient ASP efforts at Children’s Mercy Kansas City (CM) emergency departments (ED) and urgent care clinics (UCC). Methods In March 2018, we created a report defining antibiotic prescribing patterns in 16 common pediatric infections using ICD-10 codes from ED and UCC encounters. Baseline data helped identify areas for targeted interventions and establish ED/UCC engagement, which we have maintained by ongoing review and sharing of data with leadership and frontline providers. Results Baseline data showed low antibiotic prescribing rates (<5%) for most viral infections, except a rate of 74% in otitis media with effusion (OME) (Figure 1). We also identified a higher rate of cefdinir use in acute otitis media (AOM), community-acquired pneumonia, and urinary tract infections (Figure 2). We developed and shared an outpatient antibiotic handbook facilitating diagnosis and treatment of common infections. Ongoing QI teams are focusing on increasing utilization of safety-net antibiotic prescriptions for eligible patients with AOM in EDs, decreasing antibiotic prescriptions of OME, and decreasing unnecessary rapid streptococcal testing in UCCs. Through these multiple interventions, in addition to email communications and newsletter articles, we observed early improvements in prescribing patterns, including OME antibiotic prescriptions and cefdinir use (Figures 1 and 2). Conclusion We used the CDC’s core elements for outpatient ASP to successfully develop interventions in our EDs and UCCs. We created a report defining baseline prescribing patterns and identifying opportunities for improvement. Data sharing with leadership and frontline providers facilitated widespread engagement in ASP efforts. Disclosures All authors: No reported disclosures

Outcomes of an ambulatory care pharmacist-led antimicrobial stewardship program within a family medicine resident clinic

2020 ◽  
pp. 1-7
Author(s):  
Lindsey R. Westerhof ◽  
Lisa E. Dumkow ◽  
Tarajo L. Hanrahan ◽  
Samantha V. McPharlin ◽  
Nnaemeka E. Egwuatu
Keyword(s):  
Family Medicine ◽  
Ambulatory Care ◽  
Antimicrobial Stewardship ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Upper Respiratory Tract ◽  
Family Medicine Residency ◽  
Medicine Resident ◽  
Stewardship Program ◽  
Tract Infections

Abstract Objective: To determine whether an ambulatory care pharmacist (AMCP)-led intervention improved outpatient antibiotic prescribing in a family medicine residency clinic (FMRC) for upper respiratory tract infections (URIs), urinary tract infections (UTIs), and skin and soft-tissue infections (SSTIs). Design: Retrospective, quasi-experimental study comparing guideline-concordant antibiotic prescribing before and after an antimicrobial stewardship program (ASP) intervention. Setting: Family medicine residency clinic affiliated with a community teaching hospital. Participants: Adult and pediatric patients prescribed antibiotics for URI, UTI, or SSTI between November 1, 2017, and April 31, 2018 (pre-ASP group), or October 1, 2018, and March 31, 2019 (ASP group), were eligible for inclusion. Methods: The health-system ASP physician and pharmacist provided live education and pocket cards to FMRC staff with local guidelines as a quick reference. Audit with feedback was delivered every other week by the clinic’s AMCP. Guideline-concordance was determined based on the institution’s outpatient ASP guidelines. Results: Overall, 525 antibiotic prescriptions were audited (pre-ASP n = 90 and ASP n = 435). Total guideline-concordant antibiotic prescribing at baseline was 38.9% (URI, 53.3%; SSTI, 16.7%; UTI, 46.7%) and improved across all 3 infection types to 57.9% (URI, 61.2%; SSTI, 57.6%; UTI, 53.5%; P = .001). Significant improvements were seen in guideline-concordant antibiotic selection (68.9% vs 80.2%; P = .018), dose (76.7% vs 86.2%; P = .023), and duration of therapy (73.3% vs 86.2%; P = .02). Conclusions: An AMCP-led outpatient ASP intervention significantly improved guideline-concordant antibiotic prescribing for common infections within a FMRC.

Patient, Provider, and Practice Characteristics Associated with Inappropriate Antimicrobial Prescribing in Ambulatory Practices

2018 ◽  
Vol 39 (3) ◽  
pp. 307-315 ◽  
Author(s):  
Monica L. Schmidt ◽  
Melanie D. Spencer ◽  
Lisa E. Davidson
Keyword(s):  
Internal Medicine ◽  
Family Medicine ◽  
Inappropriate Prescribing ◽  
Urgent Care ◽  
Future Research ◽  
Study Cohort ◽  
Antibiotic Prescribing ◽  
Specific Patient ◽  
Antimicrobial Prescribing ◽  
Care Family

OBJECTIVETo reduce inappropriate antimicrobial prescribing across ambulatory care, understanding the patient-, provider-, and practice-level characteristics associated with antibiotic prescribing is essential. In this study, we aimed to elucidate factors associated with inappropriate antimicrobial prescribing across urgent care, family medicine, and pediatric and internal medicine ambulatory practices.DESIGN, SETTING, AND PARTICIPANTSData for this retrospective cohort study were collected from outpatient visits for common upper respiratory conditions that should not require antibiotics. The cohort included 448,990 visits between January 2014 and May 2016. Carolinas HealthCare System urgent care, family medicine, internal medicine and pediatric practices were included across 898 providers and 246 practices.METHODSPrescribing rates were reported per 1,000 visits. Indications were defined using the International Classification of Disease, Ninth and Tenth Revisions, Clinical Modification (ICD-9/10-CM) criteria. In multivariable models, the risk of receiving an antibiotic prescription was reported with adjustment for practice, provider, and patient characteristics.RESULTSThe overall prescribing rate in the study cohort was 407 per 1,000 visits (95% confidence interval [CI], 405–408). After adjustment, adult patients seen by an advanced practice practitioner were 15% more likely to receive an antimicrobial than those seen by a physician provider (incident risk ratio [IRR], 1.15; 95% CI, 1.03–1.29). In the pediatric sample, older providers were 4 times more likely to prescribe an antimicrobial than providers aged ≤30 years (IRR, 4.21; 95% CI, 2.96–5.97).CONCLUSIONSOur results suggest that patient, practice, and provider characteristics are associated with inappropriate antimicrobial prescribing. Future research should target antibiotic stewardship programs to specific patient and provider populations to reduce inappropriate prescribing compared to a “one size fits all” approach.Infect Control Hosp Epidemiol 2018;39:307–315

scholarly journals To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center

2015 ◽  
Vol 3 (1) ◽  
pp. 13-24
Author(s):  
YK Gupta ◽  
Shakti Kumar Gupta ◽  
Madhav Madhusudan Singh ◽  
DK Sharma ◽  
Aarti Kapil
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Antibiotic Stewardship ◽  
Tertiary Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Prescribing Practices ◽  
Care Teaching ◽  
Stewardship Program ◽  
Large Tertiary Care

ABSTRACT Introduction As antimicrobial resistance continues to increase and new antimicrobial development stagnates, antimicrobial stewardship programs are being implemented worldwide. The goal of antimicrobial stewardship is to optimize antimicrobial therapy with maximal impact on subsequent development of resistance. Thirty to fifty percent of hospitalized patients receive antimicrobial therapy. Previous data suggest that inappropriate use results in higher mortality rates, longer lengths of stay, and increased medical costs. Antimicrobial stewardship programs (ASPs) reduce the improper use of antimicrobials and improve patient safety. Despite increased awareness about the benefits of these programs, few medical and surgical ASPs exist and fewer comprehensive studies evaluate their effects. Aim To study the antimicrobial stewardship program in a large tertiary care teaching center. Objectives • To study the antibiotic prescribing practices in a tertiary care government hospital • To compare the antibiotic prescribing practices with the standard guidelines available with the hospital • To make recommendation if any for rational use of antibiotics. Materials and methods • Review of literature • Prospective study of 15 days in selected general medicine and general surgery ward in which 5 to 6 reading will be taken in to know the antibiotic prescribed to patients. • Retrospective study of 15 days for study of patient records to know the antibiotic prescribed to patients. • Interaction with faculty and senior residents of general medicine and surgery to know about the pattern of infection and antibiotic prescription. • Interaction with microbiology department and their faculty to know the microbial resistance pattern and possible suggestion which need to be incorporated in antibiotic Stewardship program. Results The present study on antibiotic prescribing practices was undertaken in a super specialty hospital at New Delhi. A sample size of 100 case records was considered. There is no such stewardship program in tertiary care hospital, although it was demanded in various forum and meetings. There are no recommendations available either for patients of renal failure or other such compromised metabolic or immune states in the form of written antibiotic stewardship program of the hospital. The appropriateness of antibiotics prescribed in the case records was examined in light of the antibiotic stewardship program of the hospital. It was found that the overall adherence to antibiotic stewardship program was nil as no existing antibiotic stewardship program is exiting in this hospital. Gautum Dey in a study conducted at this hospital in New Delhi found that in 40.7% preoperative cases and 60.3% postoperative cases two or more than two antibiotics were given. The author has also commented that there was no evidence of adhering to antibiotic stewardship program or utilising culture and sensitivity reports to guide the therapy. The data obtained from the present study on further analysis has shown that in seven cases, the antibiotics prescribed were inadequate in terms of dose and duration. Thus resulting in an apparently lower cost of treatment than what was recommended by the antibiotic stewardship program of the hospital. Although such inappropriate prescription results in increased chances of antibiotic resistance, the immediate or short-term effects are not very conclusive. It is observed that there were 26 (26%) cases in medical and 12 (12%) cases in surgery disciplines in which the initial and final diagnosis was different. Uncertainty about the final diagnosis promotes empirical prescribing practices. Conclusion Antimicrobial stewards are a prominent part of local and national efforts to contain and reverse antimicrobial resistance. A range of intervention options is available with varying levels of resources and can yield substantial improvements in morbidity, mortality, quality of care, and cost. The cost of delivering such programs is dwarfed by the benefits and provides an opportunity for hospital epidemiologists to garner support. This suggests that antimicrobial management programs belong to the rarefied group of truly cost saving quality improvement initiatives. Considering the enormous implications of antibiotic resistance, it is necessary that we act in haste, lest our wonder drugs and magic bullets become ineffectual. Future systems promise greater integration and analysis of data, facilitated delivery of information to the clinician, and rapid and expert decision support that will optimize patient outcomes while minimizing antimicrobial resistance. They may also offer our best hope for avoiding an ‘Antibiotic armageddon’. In addition, the ASP plays an integral role in providing guidance to clinicians and ensures that the appropriate antimicrobial agents are used. How to cite this article Singh MM, Gupta SK, Gupta YK, Sharma DK, Kapil A. To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center. Int J Res Foundation Hosp Healthc Adm 2015;3(1):13-24.

scholarly journals 1879. A 20/20 Vision: Successful Integration of a Prescribing Dashboard for Outpatient Antimicrobial Stewardship to Target 20% Reduction by the Year 2020

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S49-S49
Author(s):  
Erin Gentry ◽  
Marc Kowalkowski ◽  
Ryan Burns ◽  
Chloe Sweeney ◽  
Cliff Collins ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Urgent Care ◽  
Ambulatory Setting ◽  
Initial Increase ◽  
Relative Reduction ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Awareness Campaign ◽  
Stewardship Program ◽  
Rate Ratios

Abstract Background At least 30% of antibiotics prescribed in the ambulatory setting are unnecessary, including high rates of overuse for acute respiratory infections (ARI). We designed and evaluated whether a multifaceted outpatient stewardship program leveraging multidisciplinary stakeholder engagement, education tools, and an innovative prescribing dashboard decreased antibiotic prescribing in ARI. Methods In November 2017, the Carolinas HealthCare Outpatient Antimicrobial Stewardship Empowerment Network (CHOSEN) launched an antibiotic awareness campaign in over 150 ambulatory practices in the Charlotte metropolitan area, reaching over one million patients. The campaign included online and in-person tools for patients and providers, targeted education at meetings, and social and mass media exposure. In March 2018, a provider level prescribing dashboard was introduced to target inappropriate antibiotic prescribing in ARI (acute sinusitis, nonsuppurative otitis media, nonbacterial pharyngitis, URI, cough, allergy, and influenza). Data were collected for family medicine (FM), internal medicine (IM), urgent care (UC) and pediatric medicine (PM); 10% and 20% relative reduction targets (years 2019 and 2020, respectively) were set for each service line. We compared pre (April 2016–March 2018) vs. post (April 2018–March 2019) intervention prescribing rates (calculated as the number of encounters with antibiotics vs. total) as rate ratios and used segmented regression models to assess change over time. Results There were 1,001,335 pre and 448,390 post-intervention encounters. Postintervention prescribing rates (antibiotics per 100 encounters) decreased for all service lines, FM (49.4 to 39.3), IM (49.7 to 41.2), UC (49.8 to 44.4), and PM (40.6 to 36.1) vs. pre-intervention (all rate ratios, P ≤ 0.01). All service lines met the target 2019 10% reduction goals. Post-implementation, FM and IM showed immediate decreases in prescribing (figure). After an initial increase, UC showed a significant month-to-month decrease (figure). Conclusion Integration of a prescribing dashboard within a multifaceted antibiotic awareness campaign reduced inappropriate outpatient antibiotic prescribing for ARI and achieved interim targets consistent with 2020 reduction goals. Disclosures All Authors: No reported Disclosures.

scholarly journals 2027. What Are the Views Among Pakistani Physicians Toward Antimicrobial Resistance and Hospital Antimicrobial Stewardship Programs? A Multi-Site Qualitative Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S681-S681
Author(s):  
Khezar Hayat ◽  
Meagen Rosenthal ◽  
Ali Hassan Gillani ◽  
Panpan Zhai ◽  
Wenjing Ji ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Public Hospitals ◽  
Teaching Hospitals ◽  
Public Health Issue ◽  
Antibiotic Prescribing ◽  
Healthcare Facilities ◽  
Face To Face ◽  
Stewardship Program

Abstract Background Antimicrobial resistance (AMR) is a major public health issue that the world is facing in the 21st century and implementation of antimicrobial stewardship program (ASP) is one of the recognized approaches to combat AMR. Little is known on the views among Pakistani physicians regarding AMR and the benefits of hospital ASP implementation. This study was aimed to investigate the perception and attitude of physicians about AMR and ASP. Methods Qualitative face-to-face and telephonic interviews were conducted by using purposive sampling method with 22 physicians working in seven tertiary care public hospitals of Punjab, Pakistan. All interviews were audio-recorded and transcribed verbatim. Qualitative software was used, and a thematic analysis conducted. Results Three major themes were identified: (1) the growing concern of AMR in Pakistan, (2) the role(s) of healthcare professionals in antibiotic prescribing and infection control, and (3) managing antibiotic resistance in hospitals. Poor healthcare facilities, insufficient trained medical staff, and inadequate resources were the key barriers in the implementation of ASP in Pakistan. Conclusion Physicians of public sector tertiary care teaching hospitals have shown poor familiarity toward hospital ASPs but the concept of hospital ASPs in Pakistan can be established by using the distinct themes that originated during this study. Overall, the attitude of physicians was positive toward its enforcement in all types of hospital settings including teaching hospitals. Disclosures All authors: No reported disclosures.

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