scholarly journals An Infectious Diseases Physician-Led Antimicrobial Stewardship Program at a Small Community Hospital Associated With Improved Susceptibility Patterns and Cost-Savings After the First Year

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
Shandra R. Day ◽  
Dennis Smith ◽  
Karen Harris ◽  
Heather L. Cox ◽  
Amy J. Mathers
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Cost Savings ◽  
Acceptance Rate ◽  
First Year ◽  
Small Community ◽  
Stewardship Program ◽  
Susceptibility Patterns ◽  
Small Community Hospital

Abstract The importance of antimicrobial stewardship is increasingly recognized, yet data from community hospitals are limited. Despite an initially low acceptance rate, an Infectious Diseases physician-led program at a 70-bed rural hospital was associated with a 42% decrease in anti-infective expenditures and susceptibility improvement in Pseudomonas aeruginosa over 3 years.

Formalization of an antimicrobial stewardship program in a small community hospital

2017 ◽  
Vol 74 (17_Supplement_3) ◽  
pp. S52-S60 ◽  
Author(s):  
Alexa R. Lockwood ◽  
Nicole S. Bolton ◽  
Mark D. Winton ◽  
Jean T. Carter
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Antimicrobial Stewardship Program ◽  
Small Community ◽  
Stewardship Program ◽  
Small Community Hospital

scholarly journals 101. Impact of an Integrated Tele-Antimicrobial Stewardship Program at a Rural Community Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S164-S165
Author(s):  
Sui Kwong Li ◽  
Erin K McCreary ◽  
Erin K McCreary ◽  
Tina Khadem ◽  
Nancy Zimmerman ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Resistant Bacteria ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Material Support ◽  
Stewardship Program ◽  
Days Of Therapy

Abstract Background Small hospitals in the US may lack access to infectious diseases (ID) expertise despite similar rates of antimicrobial use and drug-resistant bacteria as larger hospitals. A tele-antimicrobial stewardship program (TASP) is a force multiplier, expanding access to specialty care, training, and guidance on appropriate resource utilization. Data on the impact of TASPs in community or rural inpatient settings is limited. Methods We established a TASP at a 160-bed hospital in Armstrong County, PA (population < 5000) in September 2020. Tele-ID consult services were already being used (Figure 1). A non-local ID pharmacist or ID physician performed prospective audits and provided feedback with 1 local pharmacist on a 30-minute video conference call daily. At TASP implementation, all patients receiving intravenous (IV) fluoroquinolones, metronidazole, and azithromycin were reviewed. Figure 1 shows the additional support following TASP implementation, including addition of ceftriaxone, carbapenems, IV vancomycin, and tocilizumab to daily reviews. A patient monitoring form was developed to track interventions and the local pharmacists were trained in documentation. Table 1 lists other TASP features implemented. Figure 1. TASP Timeline Table 1. TASP Accomplishments Results From 09/01/2020 to 04/30/2021, 304 stewardship opportunities were identified and 77% of interventions were accepted. Recommending a duration of therapy was accepted most frequently (93.5%) and de-escalation of therapy least frequently (69.6%) (Table 2). Recommending an ID consultation or diagnostic testing was always accepted but only comprised 6.2% of all interventions. Daily calls involved an average of 5 patient reviews. Monthly antimicrobial use declined on average from 673 DOT (days of therapy)/1000 PD (patient days) to 638 DOT/1000 PD (Figure 2). Daily calls were cancelled on 31/166 weekdays (18.7%) due to staffing shortages. Table 2. TASP Interventions (9/2020 - 4/2021) Figure 2. Monthly Antimicrobial Use in Days of Therapy (DOT) per 1000 Patient Days (4/2019 - 5/2021) Conclusion Implementation of TASP in a community hospital resulted in a high percentage of accepted stewardship interventions and lower antimicrobial usage. Success is dependent on robust educational efforts, establishing strong relationships with local providers, and involvement of key stakeholders. Lack of dedicated stewardship time for local pharmacists is a very significant barrier. Disclosures Erin K. McCreary, PharmD, BCPS, BCIDP, AbbVie (Consultant)Cidara (Consultant)Entasis (Consultant)Ferring (Consultant)Infectious Disease Connect, Inc (Other Financial or Material Support, Director of Stewardship Innovation)Merck (Consultant)Shionogi (Consultant)Summit (Consultant) Erin K. McCreary, PharmD, BCPS, BCIDP, AbbVie (Individual(s) Involved: Self): Consultant; Cidara (Individual(s) Involved: Self): Consultant; Entasis (Individual(s) Involved: Self): Consultant; Ferring (Individual(s) Involved: Self): Consultant; Infectious Disease Connect, Inc (Individual(s) Involved: Self): Director of Stewardship Innovation, Other Financial or Material Support; Merck (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant; Summit (Individual(s) Involved: Self): Consultant Tina Khadem, PharmD, Infectious Disease Connect, Inc. (Employee) Nancy Zimmerman, RN, BSN, I’d connect (Employee) John Mellors, MD, Abound Bio, Inc. (Shareholder)Accelevir (Consultant)Co-Crystal Pharma, Inc. (Other Financial or Material Support, Share Options)Gilead Sciences, Inc. (Advisor or Review Panel member, Research Grant or Support)Infectious DIseases Connect (Other Financial or Material Support, Share Options)Janssen (Consultant)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Employee, Director of Clinical Operations) Rima Abdel-Massih, MD, Infectious Disease Connect (Individual(s) Involved: Self): Chief Medical Officer, Other Financial or Material Support, Other Financial or Material Support, Shareholder J Ryan. Bariola, MD, Infectious Disease Connect (Other Financial or Material Support, salary support)

Improving Antimicrobial Stewardship The Evolution of Programmatic Strategies and Barriers

2011 ◽  
Vol 32 (4) ◽  
pp. 367-374 ◽  
Author(s):  
Birgir Johannsson ◽  
Susan E. Beekmann ◽  
Arjun Srinivasan ◽  
Adam L. Hersh ◽  
Ramanan Laxminarayan ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Cost Savings ◽  
The United States ◽  
Small Community ◽  
Emerging Infections ◽  
Community Hospitals ◽  
Direct Compensation ◽  
Key Barrier ◽  
Question Survey

Objective.To describe the prevalence and characteristics of antimicrobial stewardship programs (ASPs) in hospitals across the United States and to describe financial support provided for these programs.Design.Electronic and paper 14-question survey of infectious diseases physician members of the Infectious Diseases Society of America Emerging Infections Network (IDSA EIN).Participants.All 1,044 IDSA EIN members who care for adult patients were invited to participate.Results.Five hundred twenty-two (50%) members responded. Seventy-three percent of respondents reported that their institutions had or were planning an ASP, compared with 50% reporting the same thing in an EIN survey 10 years before. A shift was noted from formulary restriction alone to use of a set of tailored strategies designed to provide information and feedback to prescribers, particularly in community hospitals. Lack of funding and lack of personnel were reported as major barriers to implementing a program. Fifty-two percent of respondents with an ASP reported that infectious diseases physicians do not receive direct compensation for their participation in the ASP, compared with 18% 10 years ago.Conclusions.The percentage of institutions reporting ASPs has increased over the last decade, although small community hospitals were least likely to have these programs. In addition, ASP strategies have shifted dramatically. Lack of funding remains a key barrier for ASPs, and administrators need additional cost savings data in order to support ASPs. Interestingly, while guidelines and editorials regard compensated participation by an infectious diseases physician in these programs as critical, we found that more than half of the respondents reported no direct compensation for ASP activities.

scholarly journals Infection Preventionist Run Clostridioides difficile Testing Diagnostic Stewardship Protocol- Experience From a Rural Community Hospital

2020 ◽  
Vol 41 (S1) ◽  
pp. s484-s485
Author(s):  
Raghavendra Tirupathi ◽  
Ruth Freshman ◽  
Norma J Montoy ◽  
Melissa Gross
Keyword(s):  
Cost Savings ◽  
Antibiotic Use ◽  
First Year ◽  
Multiple Parameters ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Commercial Company ◽  
Surgical History ◽  
Test Ordering ◽  
Infection Preventionists

Background: Distinguishing active Clostridioides difficile infection (CDI) from asymptomatic colonization remains a challenging task in the era of PCR testing. Inappropriate testing leads to overtesting and overdiagnosis, inadvertent treatment, and isolation in addition to laboratory identified (LabID) events, leading to increased incidence to hospital-onset CDI (HO-CDI). The institution has a nurse-driven C. difficile test ordering protocol, and we noted a significant increase in the HO-CDI incidence in 2017 due to inappropriate testing, with rates as high as 0.94 per 1,000 patient days. Methods: In September 2017, a multidisciplinary team reviewed and initiated algorithm-based testing with mandatory audit and review by infection preventionists (IPs) under the guidance of an ID physician of all ordered tests. They reviewed the adequacy and legitimacy of order for multiple parameters, including minimum 3 loose stools in 24 hours, use of laxatives in last 24 hours, consistency of the sample, presence of at least 1 clinical parameters (ie, fever, abdominal pain, leukocytosis, sepsis, or septic shock), recent or concomitant antibiotic use, recent PCR testing in the last 14 days, and chart review for medical and/or surgical history. The IPs served as the gatekeepers to testing and rejected the samples that were deemed inappropriate. Ambiguous cases were discussed with the ID specialist. On the microscope lab side, all specimens sent were batched to be run twice a day at 8:30 a.m. and 2:30 p.m., and testing was performed only on the samples cleared by infection preventionists. Results: The number of PCR tests completed in the comparison quarter of 2016 was 220, which decreased to 157 tests in 2017 with a reduction of 28%. After a full year of implementation of the diagnostic stewardship protocol, the number of completed PCR tests decreased to 626 from 940 PCR tests in 2016, with an overall 34% decrease in testing. In the year following the implementation of diagnostic stewardship, HO-CDI decreased from 60 events in 2017 to 43 events in 2018, with a reduction of 28%. Subsequently, HO-CDI further decreased in 2019 from 43 to 28, with a reduction of 35%. Since the implementation of the project in 2017, HO-CDIs have decreased by 54% overall. The reduction in 314 C. difficile PCR tests in the first year led to a savings of $8,300 in laboratory testing supplies. The reduction of HO CDI by 17 led to cost avoidance of $293,420. Conclusions: Our experience shows that the IP-run diagnostic stewardship program was highly successful in streamlining testing, with cost savings on several fronts.Funding: NoneDisclosures: NoneDisclosures:Commercial Company : If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principals and methods, and will not promote the commercial interest of the funding company.DisagreeRaghavendra Tirupathi

scholarly journals Efficacy of a Mentoring Program on Nurse Retention and Transition Into Practice

2018 ◽  
Vol 3 (2) ◽  
pp. 31
Author(s):  
Jacquelyn D. Szalmasagi
Keyword(s):  
Community Hospital ◽  
Retention Rates ◽  
Mentoring Program ◽  
Mentor Program ◽  
Small Community ◽  
Graduate Nurses ◽  
New Graduate Nurses ◽  
New Graduate ◽  
Transition Into Practice ◽  
Small Community Hospital

Background: The United States and countries around the world are often faced with a nursing shortage. Studies indicate the reasons for the shortages include low job satisfaction and other factors leading to decreased retention rates.Purpose: The purpose of this study was to determine if participating in a mentor program impacted the transition into practice and retention rates of new graduate nurses at a small community hospital in northern Indiana.Method: This was a retrospective, descriptive, quasi-experimental study. A total of 20 new graduate nurses were studied to determine whether participation in a mentoring program had any impact on their retention at the facility. The participants who completed the mentoring program were asked to complete a questionnaire which examined their perception of the correlation between their completion of the program and their transition into practice.Results: This study determined that participating in a mentor program impacted the transition into practice and retention rates of new graduate nurses at a small community hospital in northern Indiana. The questionnaire results indicated that participation in the mentoring program helped with the new graduate nurses’ transition into practice. This study was guided by Benner’s novice to expert theory.

No Implementation Without Representation: Real-Time Pharmacist Intervention Optimizes Rapid Diagnostic Tests for Bacteremia at a Small Community Hospital

2021 ◽  
pp. 001857872110375
Author(s):  
Brandon J. Tritle ◽  
Robert Watteyne ◽  
Abby Hickman ◽  
Todd J. Vento ◽  
Bert K. Lopansri ◽  
...  
Keyword(s):  
Real Time ◽  
Diagnostic Tests ◽  
Community Hospital ◽  
Statistical Significance ◽  
Pharmacist Intervention ◽  
Rapid Diagnostic Tests ◽  
Control Group ◽  
Small Community ◽  
The Impact ◽  
Small Community Hospital

Background: Rapid diagnostic tests (RDTs) for bacteremia allow for early antimicrobial therapy modification based on organism and resistance gene identification. Studies suggest patient outcomes are optimized when infectious disease (ID)-trained antimicrobial stewardship personnel intervene on RDT results. However, data are limited regarding RDT implementation at small community hospitals, which often lack access to on-site ID clinicians. Methods: This study evaluated the impact of RDTs with and without real-time pharmacist intervention (RTPI) at a small community hospital with local pharmacist training and asynchronous support from a remote ID Telehealth pharmacist. Time to targeted therapy (TTT) in patients with bacteremia was compared retrospectively across 3 different time periods: a control without RDT, RDT-only, and RDT with RTPI. Results: Median TTT was significantly faster in both the RDT with RTPI and RDT-only groups compared with the control group (2 vs 25 vs 51 hours respectively; P < .001). TTT was numerically faster for RDT with RTPI compared with RDT-only but did not reach statistical significance ( P = .078). Median time to any de-escalation was significantly shorter for RDT with RTPI compared with both RDT-only (14 vs 33 hours; P = .012) and the control group (14 vs 45 hours; P < .001). Median length of stay was also significantly shorter in both RDT groups compared with the control group (4.0 vs 4.1 vs 5.5 hours; P = .013). Conclusion: This study supports RDT use for bacteremia in a small community hospital with ID Telehealth support, suggesting additional benefit with RTPI.

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