scholarly journals Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Jason A. Trubiano ◽  
Susan E. Beekmann ◽  
Leon J. Worth ◽  
Philip M. Polgreen ◽  
Karin A. Thursky ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Emerging Infections ◽  
Knowledge Gaps ◽  
Allergy Testing ◽  
Limited Access ◽  
Antimicrobial Prescribing ◽  
Antibiotic Allergy

Abstract Antibiotic allergy testing (AAT) practices of Emerging Infections Network infectious disease physicians were surveyed. Although AAT was perceived to be necessary for removal of inappropriate or unnecessary allergy labels, there was limited access to any form of testing. In this study, we discuss current antibiotic allergy knowledge gaps and the development of AAT practices within antimicrobial stewardship programs, which will potentially improve antimicrobial prescribing.

The Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicentre Evaluation

2017 ◽  
Vol 139 (2) ◽  
pp. AB377
Author(s):  
Jason A. Trubiano ◽  
Karen Thursky ◽  
Andrew J. Stewardson ◽  
Karen Urbancic ◽  
Leon J. Worth ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Testing Program ◽  
Allergy Testing ◽  
Antibiotic Allergy ◽  
The Impact

scholarly journals Handshake Stewardship: Interdisciplinary Rounds as a Tool to Spread Antimicrobial Stewardship Led by Hospitalist-Pharmacist Teams

2021 ◽  
Author(s):  
Sebastian Choi ◽  
Esther Ahn ◽  
Rubiya Kabir ◽  
Pranisha Gautam-Goyal ◽  
David Hirschwerk
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Advanced Practice ◽  
Team Members ◽  
Model Driven ◽  
Antimicrobial Prescribing ◽  
The Past ◽  
Antibiotic Utilization ◽  
Interdisciplinary Rounds

Abstract Background Over the past decade there has been a greater emphasis on optimizing antimicrobial stewardship. Most stewardship models rely upon a central team, often led by infectious disease doctors and pharmacists to oversee institutional prescribing. We believe there is opportunity to complement this model by incorporating stewardship into interdisciplinary rounds.ObjectiveTo access feasibility and acceptance of antimicrobial stewardship into interdisciplinary rounds.Method We piloted a stewardship model driven by hospitalists and pharmacists through interdisciplinary rounds on four medicine units. We hypothesized that our process would not hamper existing tasks of interdisciplinary rounds. We surveyed team members to understand how the initiative was experienced.ResultsMany clinicians reported that antimicrobial prescribing was ‘often’ or ‘always’ discussed, and the process was ‘not too burdensome’ to incorporate. These responses varied based on the type of provider. A majority of the advanced practice providers (88%) reported the model prompted them to reconsider their individual antimicrobial prescribing. A 28.1% overall reduction of target antibiotic utilization was realized, however, there may be other contributors to this reduction.ConclusionWe believe interdisciplinary rounds can provide a good platform to extend hospital-based antimicrobial stewardship. It was not felt to disrupt the efficiency of achieving other goals of interdisciplinary rounds.

scholarly journals Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicenter Evaluation

2017 ◽  
Vol 65 (1) ◽  
pp. 166-174 ◽  
Author(s):  
Jason A Trubiano ◽  
Karin A Thursky ◽  
Andrew J Stewardson ◽  
Karen Urbancic ◽  
Leon J Worth ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Testing Program ◽  
Allergy Testing ◽  
Narrow Spectrum ◽  
Antibiotic Allergy ◽  
Inappropriate Prescriptions

Summary An integrated antibiotic allergy testing program resulted in increased prescribing of narrow-spectrum β-lactams and reduction in restricted antibiotics and inappropriate prescriptions. The program effectively and safely de-labeled patients, with >80% of antibiotic allergy labels removed following testing.

A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers

2018 ◽  
Vol 39 (10) ◽  
pp. 1163-1169 ◽  
Author(s):  
Lauren D. Stevenson ◽  
Richard E. Banks ◽  
Krysttel C. Stryczek ◽  
Christopher J. Crnich ◽  
Emma M. Ide ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Pilot Study ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Veterans Affairs ◽  
Acceptance Rate ◽  
Term Care ◽  
Limited Access ◽  
Medical Centers ◽  
Veterans Affairs Medical Centers

AbstractObjectiveTo test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access to infectious disease-trained specialists.DesignA prospective quasi-experimental pilot study.SettingTwo rural VAMCs with acute-care and long-term care units.InterventionAt each intervention site, medical providers, pharmacists, infection preventionists, staff nurses, and off-site infectious disease physicians formed a videoconference antimicrobial stewardship team (VAST) that met weekly to discuss cases and antimicrobial stewardship-related education.MethodsDescriptive measures included fidelity of implementation, number of cases discussed, infectious syndromes, types of recommendations, and acceptance rate of recommendations made by the VAST. Qualitative results stemmed from semi-structured interviews with VAST participants at the intervention sites.ResultsEach site adapted the VAST to suit their local needs. On average, sites A and B discussed 3.5 and 3.1 cases per session, respectively. At site A, 98 of 140 cases (70%) were from the acute-care units; at site B, 59 of 119 cases (50%) were from the acute-care units. The most common clinical syndrome discussed was pneumonia or respiratory syndrome (41% and 35% for sites A and B, respectively). Providers implemented most VAST recommendations, with an acceptance rate of 73% (186 of 256 recommendations) and 65% (99 of 153 recommendations) at sites A and B, respectively. Qualitative results based on 24 interviews revealed that participants valued the multidisciplinary aspects of the VAST sessions and felt that it improved their antimicrobial stewardship efforts and patient care.ConclusionsThis pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.

scholarly journals Effects of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial prevalence and prescribing in a tertiary hospital in Singapore

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Tat Ming Ng ◽  
Sock Hoon Tan ◽  
Shi Thong Heng ◽  
Hui Lin Tay ◽  
Min Yi Yap ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Quality Indicators ◽  
Survey Methodology ◽  
Tertiary Hospital ◽  
Full Time ◽  
Full Time Equivalent ◽  
Prevalence Survey ◽  
Antimicrobial Prescribing ◽  
Point Prevalence Survey ◽  
Prescribing Quality

Abstract Background The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. Methods One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017–2019. Results The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). Conclusion During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.

scholarly journals Antibiotic Stewardship for Nursing: Can E-learning Be a First Step?

2020 ◽  
Vol 41 (S1) ◽  
pp. s118-s118
Author(s):  
Mary T. Catanzaro
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Antibiotic Stewardship ◽  
Online Survey ◽  
Interdisciplinary Approach ◽  
Healthcare Team ◽  
Learning Modules ◽  
E Learning ◽  
Unit Culture ◽  
Infection Preventionists

Background: The CDC and The Joint Commission have called for an interdisciplinary approach to antibiotic stewardship implementation. The healthcare team should consist of infectious disease physicians, pharmacists, infectious disease pharmacists, infection preventionists, microbiologists, and nurses. The scant literature to date has looked at nurses’ attitudes and beliefs toward participating in antibiotic stewardship and have identified several factors that contribute to the lack of uptake by nurses: lack of education around stewardship, poor communication among healthcare providers, and hospital or unit culture, among others. Additionally, nurses’ lack of interest in what would be more work or not within their scope of work was put forth as an additional factor by infection preventionists and pharmacists as a barrier to implementation. Method: An investigator-developed online survey was used to assess the usefulness of 3 investigator-developed educational e-learning modules that encompassed the role of nurses in antibiotic stewardship, pharmacy and laboratory topics related to antimicrobial stewardship, as well as the nurses’ attitudes toward their participation in such activities. Results: Participants took the survey after review of the 3 e-learning modules. The results indicate that, contrary to what pharmacists and infection preventionists thought, 82% of nurses felt they should contribute to and be part of the antimicrobial stewardship team. Additionally, after completing the modules, 73% felt more empowered to participate in stewardship discussions with an additional 23% wanting more education. 100% felt that they learned information that they could utilize in their everyday work. Barriers to implementation of stewardship activities on their unit included lack of education (41%), hospital or unit culture (27%), with only 4% citing they did not feel it was their job or that they had anything to contribute to a discussion. Also, 24% felt that there were no obstacles to participation. Conclusions: Surprisingly, most nurses who took this educational series and survey felt that they should be part of the antibiotic stewardship team. As cited previously from the literature, education and culture need to be addressed to overcome the nurses’ barriers to stewardship involvement. E-learning can provide an easy first step to educating nurses when time permits and can provide a good springboard for discussion on the units and with physicians and pharmacists. For a copy of the modules, please contact the author.Funding: NoneDisclosures: None

scholarly journals 1138. Script for Pediatrics: Creating a Smartphone Application to Improve Antimicrobial Prescribing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S405-S405
Author(s):  
Sarah Primhak ◽  
Natasha Pool ◽  
Gayl Humphrey ◽  
Lesley Voss ◽  
Rachel H Webb ◽  
...  
Keyword(s):  
Decision Making ◽  
Antimicrobial Stewardship ◽  
Point Of Care ◽  
Smartphone Application ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Duration Of Treatment ◽  
Antibiotic Allergy ◽  
Alternative Agent ◽  
The Impact

Abstract Background When considering antimicrobial stewardship (AMS) interventions, pediatrics is an important and often overlooked group. By 5 years of age, 97% of New Zealand (NZ) children have received antibiotics (median 8 antibiotic courses/child). Prescribing is complex due to age and weight-based adjustments, unpalatable oral preparations and inappropriate allergy labeling. Our tertiary Children’s Hospital has >250 web-based nationally utilized guidelines, 15% including antimicrobials. A point prevalence audit showed only 63% guideline adherence for inpatient antimicrobial prescriptions. We designed an accessible app to bring antibiotic prescribing and antibiotic allergy decision-making to prescribers at point of care. Methods Using local hospital and community guidelines, the national formulary and in consultation with subspecialist teams, 31 algorithms were developed. Each algorithm asked questions including diagnosis, age, antibiotic allergy history and known colonization with-resistant organisms. Results The smartphone app (Script) uses the algorithms to advise on appropriate antimicrobial, dose, route and duration of treatment. Advice regarding IV-oral switch parameters and oral antibiotic choice is provided. If allergy is suspected symptom-based decision-making enables the user to choose an alternative agent or encourages allergy de-labeling. Further AMS occurs in some algorithms when advice is given not to prescribe antimicrobials. Conclusion Script for Pediatrics launched in NZ in March 2019 with >1000 users in the first 6 weeks. The most frequently accessed guidelines are otitis media, pneumonia and meningitis. Smartphone applications with local relevance and the ability to update in real-time may prove important tools, by providing easily accessible and intuitive advice to help support antimicrobial stewardship activities. This intervention has been rapidly adopted by pediatric hospital prescribers. The impact on prescribing in concordance with guidelines, timely intravenous to oral antibiotic switch and allergy de-labeling will be assessed. Disclosures All authors: No reported disclosures.

scholarly journals Perceptions of Antimicrobial Stewardship among Infectious Disease Physicians at Two Affiliated Teaching Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s346-s348
Author(s):  
Katharina Rynkiewich ◽  
David Schwartz ◽  
Sarah Won ◽  
Brad Stoner
Keyword(s):  
Infectious Disease ◽  
Qualitative Analysis ◽  
Antimicrobial Stewardship ◽  
Ethnographic Study ◽  
Teaching Hospitals ◽  
Prescribing Behavior ◽  
Doctoral Candidate ◽  
Stewardship Program ◽  
Primary Service ◽  
Attending Physicians

Background: Two affiliated teaching hospitals in Chicago, Illinois, participated in an ethnographic study of hospital-based inpatient antimicrobial stewardship programs and interventions between 2017 and 2018. Although antimicrobial stewardship is now a requirement in medical practice, it is not clear how infectious disease physicians perceive and understand antimicrobial stewardship. Over a period of 18 months, we directly observed infectious disease practice to better understand how antimicrobial stewardship is conducted among physicians within the same specialty. Methods: A doctoral candidate medical anthropologist conducted semistructured interviews with infectious disease attending physicians and fellow physicians (N = 18) at 2 affiliated teaching hospitals in Chicago, IL, between July 2017 and March 2018 as part of an ethnographic study involving direct observation of inpatient care. Interview questions focused on 3 key domains: (1) descriptions of antimicrobial use among hospital-based physicians, (2) solicited definitions of antimicrobial stewardship, and (3) experiences practicing as an infectious disease consultant. Physicians who were directly involved with the antimicrobial stewardship program were excluded from this analysis. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Infectious disease physicians have a robust understanding of antimicrobial stewardship (Table 1). Infectious disease physicians described other hospital-based physicians as regularly overusing and misusing antimicrobials, compared with their practice, which they described as “thoughtful.” Definitions in response to the question “What is antimicrobial stewardship?” centered on guiding the prescribing behavior of others. Infectious disease physicians valued stewardship and were concerned with lack of adherence to antimicrobial prescribing recommendations among other hospital-based physicians, behaviors which infectious disease physicians viewed as perpetuating antibiotic resistance. Finally, infectious disease physicians found serving as antimicrobial stewards during their everyday practice to be challenging based on their role as consultants to the primary service. Conclusions: Our qualitative analysis revealed that infectious disease physicians not regularly involved in antimicrobial stewardship are highly motivated stewards who perceive their hospital-based colleagues to be less effective at appropriately prescribing antimicrobials. As consultants, infectious disease physicians are not autonomous decision makers. However, as antimicrobial stewardship programs search for champions, infectious disease physicians could be better utilized as knowledgeable and motivated individuals who can make the case for stewardship.Funding: NoneDisclosures: None

scholarly journals Antimicrobial stewardship in rural and remote primary health care: a narrative review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jun Wern Yau ◽  
Sze Mun Thor ◽  
Danny Tsai ◽  
Tobias Speare ◽  
Chris Rissel
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
Narrative Review ◽  
Rural And Remote ◽  
Antimicrobial Prescribing ◽  
Primary Health ◽  
Resistance Rates

Abstract Background Antimicrobial resistance is an emerging problem worldwide and poses a significant threat to human health. Antimicrobial stewardship programmes are being implemented in health systems globally, primarily in hospitals, to address the growing threat of antimicrobial resistance. Despite the significance of primary health care services in providing health care to communities, antimicrobial stewardship programmes are not well established in this sector, especially in rural and remote settings. This narrative review aims to identify in rural and remote primary health care settings the (1) correlation of antimicrobial resistance with antibiotic prescribing and volume of antibiotic use, (2) appropriateness of antimicrobial prescribing, (3) risk factors associated with inappropriate use/prescribing of antibiotics, and (4) effective antimicrobial stewardship strategies. Methods The international literature was searched for English only articles between 2000 and 2020 using specified keywords. Seven electronic databases were searched: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. Publication screening and analysis were conducted using Joanna Briggs Institute systematic review tools. Results Fifty-one eligible articles were identified. Inappropriate and excessive antimicrobial prescribing and use directly led to increases in antimicrobial resistance. Increasing rurality of practice is associated with disproportionally higher rates of inappropriate prescribing compared to those in metropolitan areas. Physician knowledge, attitude and behaviour play important roles in mediating antimicrobial prescribing, with strong intrinsic and extrinsic influences including patient factors. Antimicrobial stewardship strategies in rural and remote primary health care settings focus on health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. Results of these interventions were generally positive with decreased antimicrobial resistance rates and improved appropriateness of antimicrobial prescribing. Conclusions Inappropriate prescribing and excessive use of antimicrobials are an important contributor to the increasing resistance towards antimicrobial agents particularly in rural and remote primary health care. Antimicrobial stewardship programmes in the form of education, clinical support, surveillance, and policies have been mostly successful in reducing prescribing rates and inappropriate prescriptions. The narrative review highlighted the need for longer interventions to assess changes in antimicrobial resistance rates. The review also identified a lack of differentiation between rural and remote contexts and Indigenous health was inadequately addressed. Future research should have a greater focus on effective interventional components and patient perspectives.

scholarly journals Changes in antimicrobial prescribing behavior after the introduction of the antimicrobial stewardship program: A pre- and post-intervention survey

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
Ruchir Chavada ◽  
Harry N. Walker ◽  
Deborah Tong ◽  
Amy Murray
Keyword(s):  
Antimicrobial Stewardship ◽  
Evidence Based ◽  
Post Intervention ◽  
Electronic Decision Support ◽  
Prescribing Behavior ◽  
Antimicrobial Prescribing ◽  
Stewardship Program ◽  
Wilcoxon Rank Sum Test ◽  
Therapeutic Guidelines ◽  
Evidence Based Guidelines

The introduction of an antimicrobial stewardship (AMS) program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the <em>prescribing</em> <em>etiquette</em> described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS. Agreement with 20 statements describing attitudes (cultural, behavioral and knowledge) towards antimicrobial prescribing was assessed on a 4-point Likert scale. Mean response scores were compared using the Wilcoxon Rank sum test. 155 responses were collected before the introduction of AMS, and 144 afterwards. After the introduction of AMS, an increase was observed in knowledge about available resources such as electronic decision support systems (EDSS) and therapeutic guidelines, with raised awareness about the support available through AMS rounds and the process to be followed when prescribing restricted antimicrobials. Additionally, doctors were less likely to rely on pharmacy to ascertain when an antimicrobial was restricted, depend on infectious diseases consultant advice and use past experience to guide antimicrobial prescribing. Responses to this survey indicate that positive changes to the antimicrobial prescribing etiquette may be achieved with the introduction of an AMS program. Use of EDSS and other resources such as evidence-based guidelines are perceived to be important to drive rational antimicrobial prescribing within AMS programs.

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