scholarly journals Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use

PLoS ONE ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. e0178434 ◽  
Author(s):  
Tonya J. Campbell ◽  
Melissa Decloe ◽  
Suzanne Gill ◽  
Grace Ho ◽  
Janine McCready ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Prospective Audit And Feedback ◽  
The Impact

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 222. The Impact of Education and Prospective Audit and Feedback on Reducing Ciprofloxacin Utilization at a Small Community Academic Hospital

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S96-S96
Author(s):  
Alyssa M Thompson ◽  
Jason G Newland ◽  
Helen Newland ◽  
Jennifer Feldmann ◽  
Stephen Y Liang
Keyword(s):  
Audit And Feedback ◽  
Small Community ◽  
Prospective Audit ◽  
Academic Hospital ◽  
Prospective Audit And Feedback ◽  
The Impact

scholarly journals Can Prospective Audit and Feedback Decrease Inappropriate Antibiotic Use in Long-Term Care Facilities?

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Muhammad Salman Ashraf ◽  
Kaushal Shah ◽  
Manjit Dhillon ◽  
Hao Nguyen ◽  
Ahmed Abubaker ◽  
...  
Keyword(s):  
Long Term Care ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Term Care ◽  
Care Facilities ◽  
Prospective Audit And Feedback

Thinking Beyond the “Core” Antibiotic Stewardship Interventions: Shifting the Onus for Appropriate Antibiotic Use from Stewardship Teams to Prescribing Clinicians

2020 ◽  
Author(s):  
Timothy C Jenkins ◽  
Pranita D Tamma
Keyword(s):  
Antibiotic Stewardship ◽  
Paradigm Shift ◽  
Daily Practice ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prior Authorization ◽  
Prospective Audit ◽  
The Core ◽  
Primary Focus ◽  
Prospective Audit And Feedback

Abstract United States guidance for hospital antibiotic stewardship has emphasized prospective audit and feedback and prior authorization of select antibiotics as core interventions. These remain the most common interventions implemented by stewardship programs. Although these approaches have been shown to reduce unnecessary antibiotic use, they incorrectly put the onus for appropriate antibiotic use on the stewardship team rather than the prescribing clinician. We propose that a primary focus of stewardship programs should be implementation of broader interventions that engage frontline clinicians and equip them with tools to integrate antibiotic stewardship into their own daily practice, thus reducing the need for day-to-day stewardship team oversite. We discuss a framework of broader interventions and policies that will facilitate this paradigm shift.

scholarly journals 83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S58-S59
Author(s):  
Casey J Dempsey ◽  
Natasha Weiner ◽  
Michele Riccardi ◽  
Kristin Linder
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Audit And Feedback ◽  
Small Community ◽  
Prospective Audit ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
The Impact ◽  
Feedback Program

Abstract Background Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital. Methods A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI). Results Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p < 0.001), ciprofloxacin (23.22 vs. 9.97; p < 0.001), levofloxacin (11.2 vs. 5.07; p < 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p < 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p < 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p < 0.001), levofloxacin ($2,168 vs. $672; p < 0.001), ciprofloxacin ($6,700 vs. $1,954; p < 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p < 0.001). Conclusion Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives. Disclosures All Authors: No reported disclosures

scholarly journals 38. Impact of Antimicrobial Stewardship Interventions on Adherence to Clostridioides difficile Treatment Guidelines

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Elizabeth Neuner ◽  
Tamara Krekel ◽  
Michael Durkin ◽  
Erik R Dubberke ◽  
Kevin Hseuh
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Treatment Guideline ◽  
Small Sample ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Research Support ◽  
Post Intervention ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background Facility-specific treatment guidelines are a priority intervention recommended in the CDC Core Elements of Hospital Antimicrobial Stewardship Programs (ASPs). Our ASP sought to improve adherence to the facility C. difficile infection (CDI) treatment guideline by implementing prospective audit and feedback of CDI cases, changing fidaxomicin from being restricted to Infectious Diseases consult use, to only requiring prospective audit and feedback, and allowing fidaxomicin and oral vancomycin orders only through the order set. This study reviews the impact of these interventions. Methods This single-center retrospective quasi-experimental study evaluated inpatient CDI lab events 3 months pre-intervention (10/1/2019-12/31/2019) and post-intervention (10/14/2020-1/14/2021). Patient and treatment data was evaluated via chart review. The primary outcome was adherence to CDI treatment guideline. ASP intervention types were categorized. Statistical analyses were performed using Chi-squared or Fischer’s exact, where appropriate. Results Baseline characteristics were well matched between the 58 and 70 patients pre and post intervention respectively (Table 1). ASP interventions resulting from the prospective audit and feedback are described in Table 2 and overall acceptance rates were high (88%). Guideline adherence improved significantly from 71% pre to 90% post-intervention (p=0.005). Reasons for non-adherence included vancomycin dose incorrect for the severity of illness (9 pre vs 2 post), inappropriate duration (4 pre vs 0 post), use of combination therapy in non-fulminant disease (5 pre vs 3 post), and not using fidaxomicin for recurrent disease (3 pre vs 2 post). Clinical outcomes pre and post intervention were not different in this small sample size: colectomy 1 (2%) vs 1 (1%) p=1, 60 day all- cause mortality 15 (26%) vs 14 (20%) p=0.43, and CDI recurrence at day 60 9/43 (21%) vs 5/56 (9%) p=0.131. Conclusion A bundle of ASP interventions including prospective audit and feedback of CDI cases improved adherence to facility-specific CDI treatment guidelines. Disclosures Tamara Krekel, PharmD, BCPS, BCIDP, Merck (Speaker’s Bureau) Erik R. Dubberke, MD, MSPH, Ferring (Grant/Research Support)Merck (Consultant)Pfizer (Consultant, Grant/Research Support)Seres (Consultant)Summit (Consultant)

scholarly journals 757. Impact of a Sepsis Improvement Team with Prospective Audit and Feedback on SEP-1 Core Measure Adherence in an Urban Community Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S338-S338
Author(s):  
Alfredo J Mena Lora ◽  
Sue Sim ◽  
Sherrie Spencer ◽  
Yolanda Coleman ◽  
Candice Krill ◽  
...  
Keyword(s):  
Community Hospital ◽  
Urban Community ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Immediate Feedback ◽  
Order Sets ◽  
Core Measure ◽  
Prospective Audit And Feedback ◽  
The Impact ◽  
Improvement Team

Abstract Background Adherence to the CMS sepsis core measure (SEP-1) has been a challenge for facilities nationwide. Checklists, electronic medical record (EMR) alerts and order sets have been shown to improve compliance. We implemented a comprehensive SEP-1 guideline with order sets, checklists and EMR alerts at an urban community hospital. Subsequently, a SEP-1 improvement team with an infectious disease physician and a nurse led a prospective audit and feedback (PAF) program to help improve adherence and reduce errors. We seek to understand the impact of PAF on SEP-1 compliance. Methods Quasi-experimental pre- and post-intervention study of SEP-1 compliance at a 151-bed urban community hospital from January 2015 to December 2018. PAF intervention was started on July 2017. Cases were reviewed, SEP-1 failures identified, and feedback given to nurses and clinicians involved within 48 hours of admission. Gaps in adherence are identified, education given, and corrective actions taken. SEP-1 adherence before and after PAF implementation was reviewed. Results A total of 307 cases met the SEP-1 inclusion criteria. PAF was successfully implemented. There were 169 SEP-1 cases before and 138 after implementation of PAF. The success rate increased from 44% to 52% with PAF (Figure 1). The most common reasons for failure were initial and repeat lactic acid on both groups (Figure 2). Conclusion Prospective audit and feedback for SEP-1 improved compliance rates at our facility. Prospective audit can help identify core measure failures early and provide immediate feedback to clinicians, nurses and laboratory personnel. Immediate feedback by the SEP-1 improvement team may help increase SEP-1 awareness, strengthen existing protocols and promote a culture of safety. SEP-1 is a complex core measure that may transition to pay-for-performance. An ID physician-led SEP-1 improvement team with PAF may be an area for future value-based care opportunities for ID physicians. Disclosures All authors: No reported disclosures.

scholarly journals Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing

2021 ◽  
pp. 1-8
Author(s):  
Katie J. Suda ◽  
Gosia S. Clore ◽  
Charlesnika T. Evans ◽  
Heather Schacht Reisinger ◽  
Ibuola Kale ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Pathways ◽  
Statistical Significance ◽  
Implementation Strategies ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prior Approval ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
Advanced Generation

Abstract Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. Results: Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were “completely” accepted had lower fluoroquinolone rates than sites where it was “moderately” accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) “would” or “may” be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. Conclusions: PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.

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