scholarly journals Fixed vs. Free-text Documentation of Indication for Antibiotic Orders

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S325-S326 ◽  
Author(s):  
Waleed Javaid ◽  
Shaelyn Cavanaugh ◽  
Christina Lupone ◽  
Telisa Stewart ◽  
Tasaduq Fazili ◽  
...  
Keyword(s):  
Time Frame ◽  
Poor Quality ◽  
Quality Metrics ◽  
Free Text ◽  
Antimicrobial Use ◽  
Text Entry ◽  
Program Outcomes ◽  
Adherence To Guidelines ◽  
Stewardship Program ◽  
Enormous Variation

Abstract Background Requiring indications for antimicrobial orders can allow stewardship programs to evaluate adherence to guidelines and assess outcomes. We extracted indication data from our institution’s EPIC system and found that in a 29-month time frame there were 12,218 uniquely entered indications. Only 136 of these were standardized drop-down (fixed) menu options; the rest were entered manually (free-text). Enormous variation in these uniquely typed entries emphasizes the value and necessity of fixed indication options to allow for better evaluation of stewardship program outcomes. Methods We evaluated the 718 most commonly used indications accounting for a total of 113,741 unique antibiotic orders for 42,665 patients. We excluded indications used for less than 36 orders during the study period. We analyzed the characteristics of these orders to identify opportunities for improvement in indication documentation and developed a new list of less than 200 indications that could account for nearly all of the various indications entered. Results 66,404 (58%) orders were placed using fixed options available in the menu (Figure 1). 32,427 (29%) orders were placed with no indication listed. The remaining 14,910 (13%) orders were documented with free-text indications. Within these manual entries, 59% were identical or nearly identical to an option that was available in the drop down menu. 37% of free-text indications could not be appropriately placed with an option available in the menu. For example, the menu contained a fixed option for “Severe C. difficile infection” forcing all non-severe cases to be entered as varied free-text alternatives (Figures 2 and 3). Conclusion In our sample, use of fixed menu options was high but robust evaluation of proper antimicrobial use was substantially limited by failure to document indication and free-text entry by providers. Free-text entry and blank fields can be used as quality metrics, with high use indicating poor quality. We recommend that standard comprehensive indication lists are developed, providers are encouraged and empowered to utilize menu options consistently, and computerized order systems are programmed to prevent orders from being placed without an indication listed. Disclosures All authors: No reported disclosures.

scholarly journals Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 5
Author(s):  
Sílvia Simó ◽  
Eneritz Velasco-Arnaiz ◽  
María Ríos-Barnés ◽  
María Goretti López-Ramos ◽  
Manuel Monsonís ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Fatality ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Length Of Therapy ◽  
Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

scholarly journals Researchers’ perceptions of malaria eradication: findings from a mixed-methods analysis of a large online survey

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Joe Brew ◽  
Menno Pradhan ◽  
Jacqueline Broerse ◽  
Quique Bassat
Keyword(s):  
Online Survey ◽  
Cost Benefit ◽  
Time Frame ◽  
Free Form ◽  
Free Text ◽  
Specific Investments ◽  
Uncertain Outcome ◽  
Malaria Eradication ◽  
Global Eradication

Abstract Background The value of malaria eradication, the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites, would be enormous. However, the expected value of an investment in an intended, but uncertain, outcome hinges on the probability of, and time until, its fulfilment. Though the long-term benefits of global malaria eradication promise to be large, the upfront costs and uncertainty regarding feasibility and timeframe make it difficult for policymakers and researchers to forecast the return on investment. Methods A large online survey of 844 peer-reviewed malaria researchers of different scientific backgrounds administered in order to estimate the probability and time frame of eradication. Adjustments were made for potential selection bias, and thematic analysis of free text comments was carried out. Results The average perceived likelihood of global eradication among malaria researchers approximates the number of years into the future: approximately 10% of researchers believe that eradication will occur in the next 10 years, 30% believe it will occur in the next 30 years, and half believe eradication will require 50 years or more. Researchers who gave free form comments highlighted systemic challenges and the need for innovation as chief among obstacles to achieving global malaria eradication. Conclusions The findings highlight the difficulty and complexity of malaria eradication, and can be used in prospective cost–benefit analyses to inform stakeholders regarding the likely return on eradication-specific investments.

scholarly journals Promoting Antimicrobial Stewardship Education Among Pediatricians Through a Maintenance of Certification Part 4 Quality Impro

2021 ◽  
Vol 1 (S1) ◽  
pp. s29-s29
Author(s):  
Prachi Singh ◽  
Brian Lee ◽  
Jenna Holmen
Keyword(s):  
Antimicrobial Stewardship ◽  
Transition Period ◽  
Surgical Patients ◽  
Antimicrobial Use ◽  
Maintenance Of Certification ◽  
Stewardship Program ◽  
Surgical Antibiotic Prophylaxis ◽  
Baseline Knowledge ◽  
Initial Survey ◽  
The Impact

Background: The rise of antimicrobial resistance has made it critical for clinicians to understand antimicrobial stewardship principles. We sought to determine whether the opportunity to participate in an American Board of Pediatrics Maintenance of Certification Part 4 (MOC4) quality improvement (QI) project would engage pediatricians and improve their knowledge about antimicrobial stewardship. Methods: In August 2019, a new clinical algorithm for acute appendicitis, spearheaded by the antimicrobial stewardship program (ASP), was implemented at UCSF Benioff Children’s Hospital Oakland to standardize care and optimize antimicrobial use. Medical staff were invited to participate in a QI project evaluating the impact of this algorithm. Data were collected for the 2 quarters preceding implementation (baseline), for the quarter of implementation (transition period), and for the quarter after implementation. Participants were offered MOC4 credit for reviewing these 3 cycles of data and associated materials highlighting information about antimicrobial stewardship. An initial survey was given to participants to assess their baseline knowledge via 4 questions about antimicrobial use in surgical patients (Table 1). At the conclusion of the QI project, another survey was conducted to reassess participant knowledge and to evaluate overall satisfaction with the project. Results: In total, 150 clinicians completed the initial survey. Of these, 44% were general pediatricians and 56% were pediatric subspecialists. Based on years out of training, their levels of experience varied: >20 years in 24%, 11–20 years in 32.7%, 0–10 years in 34.7%, and currently in training in 8.7%. Of the 150 initial participants, 133 (89%) completed the QI project and the second survey. Between surveys, there was significant improvement in knowledge about the appropriate timing and duration of surgical antibiotic prophylaxis (Table 1). Moreover, 88% of participants responded that the QI project was extremely effective in helping them learn about antimicrobial stewardship principles and about ASP interventions. Conclusions: Participation in this MOC4 QI project resulted in significant improvement in knowledge about antimicrobial use in surgical patients, and the activity was perceived as a highly effective way to learn about antimicrobial stewardship. QI projects that leverage MOC4 credit can be a powerful tool for engaging pediatricians and disseminating education about antimicrobial stewardship.Funding: NoDisclosures: None

scholarly journals Antimicrobial stewardship program in China’s tertiary hospitals in 2018: a nationwide cross-sectional online survey

2020 ◽  
Author(s):  
Yue Zhou ◽  
Haishaerjiang Wushouer ◽  
Xi Zhang ◽  
Jiajia Feng ◽  
Likai Lin ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Evaluation System ◽  
Clinical Pathways ◽  
Popular Science ◽  
Outcome Evaluation ◽  
Antimicrobial Use ◽  
Cross Sectional ◽  
Prescription Audit ◽  
Stewardship Program ◽  
Tertiary Hospitals

Abstract Background The study aimed to assess the development of antimicrobial stewardship (AMS) program in China’s tertiary hospitals to identify the potential challenges for AMS program and provide references and benchmarks for strategic policymaking. Methods A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System (CARSS) between November 1, 2018 and December 10, 2018. The questionnaire included 5 sections regarding structure, technical support, antimicrobial use management, antimicrobial use surveillance and education. Descriptive statistics were used for data analysis. Results Of 1044 tertiary hospitals under CARSS, 13.4% (140) hospitals participated in the study. Among them, 99.3% (139/140) set up AMS program. Hospital president (82.1%, 115/140) and medical service department (59.3%, 83/140) were responsible for AMS outcomes in most hospitals. Structured antimicrobial formulary restriction management was adopted by 99.3% (139/140) hospitals. Infection disease department, infection control department and microbiological laboratories were established in 87.1% (122/140), 99.3% (139/140), and 100% (140/140) hospitals, respectively. Up to 85.6% (124/140) hospitals applied clinical pathways and 33.6% (47/140) hospitals implemented hospital-specific guidelines for infectious diseases. Outpatient prescription audit, inpatient prescription audit and prophylactic antimicrobial prescription audit of aseptic operation were performed in 99.3% (139/140), 98.6% (138/140) and 95.7% (134/140) hospitals, respectively. Up to 97.1% (136/140) hospitals participated in antimicrobial use surveillance network and 99.3% (139/140) hospitals established the specialized management of carbapenem and tigecycline. Staff education and AMS-related popular science education were provided with different ways and frequency in 100% (140/140) and 88.6% (124/140) hospitals, respectively. Conclusions AMS in China’s tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments. More efforts should be put into further promoting and strengthening the development of hospital-specific guidelines and the establishment of progress and outcome evaluation system.

RingText: Dwell-free and hands-free Text Entry for Mobile Head-Mounted Displays using Head Motions

2019 ◽  
Vol 25 (5) ◽  
pp. 1991-2001 ◽  
Author(s):  
Wenge Xu ◽  
Hai-Ning Liang ◽  
Yuxuan Zhao ◽  
Tianyu Zhang ◽  
Difeng Yu ◽  
...  
Keyword(s):  
Free Text ◽  
Text Entry ◽  
Head Mounted Displays

The role of electronic health record and “add-on” clinical decision support systems to enhance antimicrobial stewardship programs

2019 ◽  
Vol 40 (05) ◽  
pp. 501-511 ◽  
Author(s):  
Kristi M. Kuper ◽  
Jerod L. Nagel ◽  
Jarrod W. Kile ◽  
Larissa S. May ◽  
Francesca M. Lee
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Healthcare Systems ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Reporting Requirements ◽  
It Systems ◽  
Stewardship Program

AbstractIncreasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.

Development of an antimicrobial stewardship program in an integrated healthcare system

2018 ◽  
Vol 76 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Michael A Lane ◽  
Amanda J Hays ◽  
Helen Newland ◽  
Jeanne E Zack ◽  
Rebecca M Guth ◽  
...  
Keyword(s):  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Gap Analysis ◽  
System Level ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Integrated Healthcare ◽  
Stewardship Program ◽  
Regulatory Mandates ◽  
The Impact

Abstract Purpose The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. Summary With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4–8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. Conclusion BJC’s ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.

scholarly journals Provincial and Temporal Variation in Macrolide and Lincosamide Antimicrobial Use by Outpatients in Canada, 1995 to 2010

2014 ◽  
Vol 25 (2) ◽  
pp. 103-106 ◽  
Author(s):  
Shiona K Glass-Kaastra ◽  
Rita Finley ◽  
Jim Hutchinson ◽  
David M Patrick ◽  
Karl Weiss ◽  
...  
Keyword(s):  
Mixed Models ◽  
Repeated Measures ◽  
Secular Trend ◽  
Time Frame ◽  
Antimicrobial Use ◽  
Patterns Of Use ◽  
Defined Daily Doses ◽  
The Mean ◽  
Canadian Provinces ◽  
Over Time

INTRODUCTION: Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is very important.OBJECTIVE: To assess the use of macrolide and lincosamide (ML) antimicrobials within Canadian provinces over time, and to compare use rates with those reported by European countries.METHODS: Antimicrobial prescribing data were used to develop two yearly metrics: prescriptions per 1000 inhabitant-days (PrIDs) and the mean defined daily doses (DDDs) per prescription, which were then used to build linear mixed models to assess differences among provinces over time.RESULTS: After accounting for repeated measures over time, prescribing rates (PrIDs) varied significantly according to province and year (P<0.001). However, little change occurred within each province over the time frame studied; from 1995 to 2010, each province had a PrID change <0.01. Quebec and British Columbia had significantly lower prescribing rates than all other provinces. No overall secular trend was apparent. In contrast, the DDDs per prescription did not vary significantly according to province, but showed a significant year-to-year increase.DISCUSSION: ML prescribing varied among provinces in Canada between 1995 and 2010, but remained relatively stable within each province. The average DDDs per ML prescription did not vary according to province, but increased linearly over time. These increases are likely to indicate that fewer prescriptions are being written for children over time, a practice supported by good antimicrobial stewardship principles.

scholarly journals Effects of a Remote Antimicrobial Stewardship Program on Antimicrobial Use in a Regional Hospital System

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 41 ◽  
Author(s):  
Joshua Knight ◽  
Jessica Michal ◽  
Stephanie Milliken ◽  
Jenna Swindler
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Use ◽  
Hospital System ◽  
Physician Review ◽  
Stewardship Program ◽  
Time Period ◽  
Days Of Therapy ◽  
Before And After ◽  
Implementation Time ◽  
Acceptance Rates

While antimicrobial stewardship programs (ASPs) are well established at most large medical centers, small or rural facilities often do not have the same resources; therefore, different methods must be developed to start or expand ASPs for these hospitals. The purpose of this quality improvement study was to describe the implementation of a pharmacist-led remote ASP and assess the effect on antimicrobial use. Antimicrobial use in days of therapy per 1000 patient days (DOT/1000 PD) was compared between the six months before and after remote ASP implementation. Changes in system-wide, facility-specific, and target antimicrobial use were evaluated. Pharmacist interventions, acceptance rates, and number of times infectious disease (ID) physician assistance was sought were also tracked. System-wide antimicrobial use was 4.6% less in the post-implementation time period than in the pre-implementation time period, with vancomycin, piperacillin/tazobactam, and fluoroquinolones having the greatest reductions in use. Ninety-one percent of interventions made during the post-implementation period were accepted. ID physician review was requested 38 times, and direct ID physician intervention was required six times. Remote ASPs delivered from a central facility to serve a larger system may reduce antimicrobial use, especially against targeted agents, with minimal increase in ID physician workload.

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