scholarly journals Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252407
Author(s):  
Daniel Doyle ◽  
Gerald McDonald ◽  
Claire Pratt ◽  
Zahra Rehan ◽  
Tammy Benteau ◽  
...  
Keyword(s):  
Decision Support ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Support Tool ◽  
Survey Tool ◽  
Before And After ◽  
The Impact

Objectives Inappropriate antibiotic use contributes to antimicrobial resistance. The SpectrumTM app provides antibiotic decision support, based on local antimicrobial resistance rates. We determined the impact of regional implementation of the app on inpatient antimicrobial appropriateness, inpatient antimicrobial usage (AMU), population-based Clostridioides difficile infection (CDI) rates and cost, using a retrospective, before and after quasi-experimental design, including a one-year study period. Methods The SpectrumTM app was released to prescribers in February, 2019. We performed two one-day inpatient point prevalence surveys using the National Antimicrobial Prescribing Survey tool, six months before (June 25, 2018) and six months after (June 25, 2019) app dissemination. Inpatient AMU in Defined Daily Dose/1000 patient days and CDI incidence were compared, before and after app dissemination. Results The pre-survey included 184 prescriptions, and the post-survey included 197 prescriptions. Appropriateness was 97/176 (55.1%) pre, and 126/192 (65.6%) post (+10.5%, p = 0.051). Inpatient AMU declined by 6.6 DDD/1000 patient days per month, and CDI declined by 0.3 cases per month. Cost savings associated with reduced AMU were $403.98/bed/year and associated with reduced CDI were $82,078/year. Conclusion We observed improvement in antimicrobial stewardship indicators following SpectrumTM implementation. We cannot determine the cause of these improvements.

scholarly journals IMPACT OF ANTIMICROBIAL STEWARDSHIP PROGRAM ON THE USE OF ANTIBIOTICS IN PNEUMONIA PATIENTS AT TEACHING HOSPITAL IN SURAKARTA INDONESIA

2021 ◽  
pp. 20-23
Author(s):  
HIDAYAH KARUNIAWATI ◽  
TRI YULIANTI ◽  
DEWI KUROTA AINI ◽  
FINISHIA ISNA NURWIENDA
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Study Data ◽  
Defined Daily Dose ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Daily Dose ◽  
The Impact ◽  
Method Show

Objective: Antibiotic resistance is a serious problem worldwide. One cause of antibacterial resistance is the inappropriate use of antibiotics. Thestudy of antibiotic use in hospitals found that 30–80% were not based on indications. Antimicrobial Stewardship Programs (ASP) was developed tocontrol antimicrobial resistance. This study aims to evaluate the impact of ASP in pneumonia patients qualitatively and quantitatively pre-post ASPapplied.Methods: This research is a non-experimental study. Data were taken from the medical records of pneumonia patients and analyzed qualitativelyusing the Gyssens method and quantitatively using the Defined Daily Dose (DDD) method. Sampling was conducted through purposive sampling andresults were described descriptively.Results: During the study period, 96 samples were obtained with 48 data pre-ASP and 48 data post-ASP. The results of the qualitative analysis usingthe Gyssens method show an increase in the prudent use of antibiotics from 31.25% to 62.5% pre-post ASP, respectively. Quantitative evaluationshows a decrease of antibiotic use pre-post ASP from 90.84 DDD/100 patients-days to 61.42 DDD/100 patients-days.Conclusion: The ASP can improve the quality of antibiotic use in pneumonia patients quantitatively and qualitatively.

An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility

2016 ◽  
Vol 38 (1) ◽  
pp. 76-82 ◽  
Author(s):  
Sara Tedeschi ◽  
Filippo Trapani ◽  
Maddalena Giannella ◽  
Francesco Cristini ◽  
Fabio Tumietto ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Antibiotic Consumption ◽  
Defined Daily Dose ◽  
Antimicrobial Stewardship Program ◽  
Rehabilitation Hospital ◽  
Stewardship Program ◽  
Resistance Patterns ◽  
The Impact

OBJECTIVETo assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital.DESIGNQuasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation.SETTING150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries.INTERVENTIONBeginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods before and after the ASP implementation.RESULTSAntibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days (P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001). Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to 12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBL-producing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis (P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17% (P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40% (P<.0008).CONCLUSIONSAn ASP based on ID consultation was effective in reducing antibiotic consumption without affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital.Infect Control Hosp Epidemiol. 2016;1–7

scholarly journals Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 136
Author(s):  
Andrew B. Watkins ◽  
Trevor C. Van Schooneveld ◽  
Craig G. Reha ◽  
Jayme Anderson ◽  
Kelley McGinnis ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Antimicrobial Stewardship ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Secondary Outcome ◽  
Support Tool ◽  
Pharmacist Interventions ◽  
Days Of Therapy ◽  
Tract Infections

In 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to review patients on antibiotics with procalcitonin (PCT) <0.25 mcg/L. This study used a retrospective cohort design to assess change in antibiotic use from pharmacist interventions after this PCT alert in patients on antibiotics for lower respiratory tract infections (LRTI). The secondary outcome was antibiotic days of therapy (DOT), with a subgroup analysis examining antibiotic use and the length of stay (LOS) in patients with a pharmacist intervention. From 1/2019 to 11/2019, there were 165 alerts in 116 unique patients on antibiotics for LRTI. Pharmacists attempted interventions after 34 (20.6%) of these alerts, with narrowing spectrum or converting to oral being the most common interventions. Pharmacist interventions prevented 125 DOT in the hospital. Vancomycin was the most commonly discontinued antibiotic with an 85.3% use reduction in patients with interventions compared to a 27.4% discontinuation in patients without documented intervention (p = 0.0156). The LOS was similar in both groups (median 6.4 days vs. 7 days, p = 0.81). In conclusion, interventions driven by a CDS tool for pharmacist-driven antimicrobial stewardship in patients with a normal PCT resulted in fewer DOT and significantly higher rates of vancomycin discontinuation.

scholarly journals Supporting antimicrobial stewardship in Ghana: evaluation of the impact of training on knowledge and attitudes of healthcare professionals in two hospitals

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Jacqueline Sneddon ◽  
Lesley Cooper ◽  
Daniel Kwame Afriyie ◽  
Israel A Sefah ◽  
Alison Cockburn ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Hospital Staff ◽  
Municipal Hospital ◽  
Behavioural Science ◽  
Before And After ◽  
Survey Responses ◽  
The Impact

Abstract Background A Commonwealth Partnership for Antimicrobial Stewardship was created between the Scottish Antimicrobial Prescribing Group (SAPG), Ghana Police Hospital and Keta Municipal Hospital. During a scoping visit, requirements for implementing antimicrobial stewardship (AMS), areas for improvement and training needs were identified. Methods A multidisciplinary team from SAPG and health psychologists from The Change Exchange developed and delivered multi-professional evidence-based teaching incorporating behavioural science, supported by partner pharmacists in each hospital. Four sessions were delivered over 2 days to 60 participants across both sites. Before and after the sessions, participants were asked to complete a knowledge quiz and a behaviours survey. Results were analysed using t-tests. Results Comparison of the participants’ pre- and post-test quiz scores (Keta Municipal Hospital 9.4 and 10.9, Ghana Police Hospital 9.2 and 11.1, respectively) demonstrated statistically significant improvement in knowledge of antimicrobial resistance and appropriate use of antibiotics. Comparison of survey responses before and after the education sessions indicated that the education had a positive impact on participants’ attitudes towards the issue of antimicrobial resistance, their role in AMS and confidence in using the Ghana Standard Treatment Guidelines. Participants were also more likely to question colleagues about compliance with guidelines. Forty-eight participants (80%) completed a training evaluation and all responded positively. Conclusions The education sessions appeared to be successful in improving knowledge and behaviours of hospital staff. Cascade of an abbreviated version of the training by partner pharmacists and AMS teams in Ghana will ensure that all staff have the opportunity to develop skills and knowledge to support AMS.

scholarly journals Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients

2017 ◽  
Vol 55 (12) ◽  
pp. 3350-3354 ◽  
Author(s):  
D. Nikolic ◽  
S. S. Richter ◽  
K. Asamoto ◽  
R. Wyllie ◽  
R. Tuttle ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Cost Savings ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Content Type ◽  
Support Tool ◽  
Clinical Decision Support Tool ◽  
The Impact ◽  
Stool Cultures

ABSTRACTThere is substantial evidence that stool culture and parasitological examinations are of minimal to no value after 3 days of hospitalization. We implemented and studied the impact of a clinical decision support tool (CDST) to decrease the number of unnecessary stool cultures (STCUL), ova/parasite (O&P) examinations, andGiardia/Cryptosporidiumenzyme immunoassay screens (GC-EIA) performed for patients hospitalized >3 days. We studied the frequency of stool studies ordered before or on day 3 and after day 3 of hospitalization (i.e., categorical orders/total number of orders) before and after this intervention and denoted the numbers and types of microorganisms detected within those time frames. This intervention, which corresponded to a custom-programmed hard-stop alert tool in the Epic hospital information system, allowed providers to override the intervention by calling the laboratory, if testing was deemed medically necessary. Comparative statistics were employed to determine significance, and cost savings were estimated based on our internal costs. Before the intervention, 129/670 (19.25%) O&P examinations, 47/204 (23.04%) GC-EIA, and 249/1,229 (20.26%) STCUL were ordered after 3 days of hospitalization. After the intervention, 46/521 (8.83%) O&P examinations, 27/157 (17.20%) GC-EIA, and 106/1,028 (10.31%) STCUL were ordered after 3 days of hospitalization. The proportions of reductions in the number of tests performed after 3 days and the associatedPvalues were 54.1% for O&P examinations (P< 0.0001), 22.58% for GC-EIA (P= 0.2807), and 49.1% for STCUL (P< 0.0001). This was estimated to have resulted in $8,108.84 of cost savings. The electronic CDST resulted in a substantial reduction in the number of evaluations of stool cultures and the number of parasitological examinations for patients hospitalized for more than 3 days and in a cost savings while retaining the ability of the clinician to obtain these tests if clinically indicated.

scholarly journals Combating resistance while maintaining innovation: the future of antimicrobial stewardship

2019 ◽  
Vol 14 (15) ◽  
pp. 1331-1341 ◽  
Author(s):  
Richard J Vickers ◽  
Matteo Bassetti ◽  
Cornelius J Clancy ◽  
Kevin W Garey ◽  
David E Greenberg ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Global Health ◽  
Antimicrobial Stewardship ◽  
Return On Investment ◽  
Antibiotic Use ◽  
Personal Perspective ◽  
Control Programs ◽  
Interdisciplinary Nature ◽  
The Future ◽  
The Impact

Antimicrobial resistance represents a significant global health threat. However, a commercial model that does not offer a return on investment resulting in a lack of investment in antibiotic R&D, means that the current pipeline of antibiotics lacks sufficient innovation to meet this challenge. Those responsible for defining, promoting and monitoring the rationale use of antibiotics (the antimicrobial stewardship programme) are key to addressing current shortcomings. In this personal perspective, we discuss the future role stewardship can play in stimulating innovation, a need to move away from a pharmacy budget dominated view of antibiotic use, and the impact of the ever-increasing sophistication and interdisciplinary nature of antimicrobial control programs. Changes are needed to optimize clinical outcomes for patients.

scholarly journals 86. Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Andrew B Watkins ◽  
Trevor C Van Schooneveld ◽  
Craig Reha ◽  
Jayme Anderson ◽  
Kelley McGinnis ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Antimicrobial Stewardship ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Pharmacist Intervention ◽  
Support Tool ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Tract Infections

Abstract Background Our Antimicrobial Stewardship Program (ASP) instituted review of patients on antibiotics with procalcitonin (PCT) &lt; 0.25 mcg/L in 2012. In 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to assist in this patient review. We sought to validate the effectiveness of this tool for pharmacist-led PCT-based antibiotic stewardship. Methods A retrospective cohort design was used to assess antibiotic de-escalation after PCT alert in patients on antibiotics for lower respiratory tract infections (LRTI). Secondary outcomes included antibiotic use and length of stay (LOS) in patients with PCT interventions vs those without. Results From 1/2019 to 11/2019, 652 of 976 (66.8%) PCT alerts were addressed by pharmacists. Of these, 331 were in patients with a respiratory-related diagnosis at discharge and 165 alerts were in patients on antibiotics specifically for LRTI over 119 encounters. Pharmacists made or attempted interventions after 34 (20.6%) of these alerts, with narrowing spectrum or converting to oral therapy being the most common interventions. Antibiotics were completely stopped in 4 of these interventions (11.8%). Patients with pharmacist intervention had 125 fewer antibiotic days of therapy (DOT) in the hospital, and changes were made to an additional 56 DOT (narrower therapy, IV to PO, dose optimization) following the alert. Two cases (5.9%) subsequently had therapy escalated within 48 hours. Vancomycin was the most commonly discontinued antibiotic with an 85.3% use reduction in patients with interventions compared to 27.4% discontinuation in patients with no documented intervention (p=0.0156). Alerts eligible for de-escalation but with no pharmacist intervention represented 140 DOT. LOS was similar in patients from both groups (median 6.4 days vs. 7 days, p=0.81). Conclusion Interventions driven by a CDS tool for pharmacist-driven antimicrobial stewardship in patients with normal PCT resulted in fewer DOT and significantly higher rates of vancomycin discontinuation. Additional interventions could have potentially prevented 140 DOT. We feel refinement of this tool can lead to more meaningful CDS, reduce alert fatigue, and likely increase intervention rates. Disclosures All Authors: No reported disclosures

scholarly journals The Impact of Antimicrobial Stewardship Program on Injudicious Use of Cefuroxime

2021 ◽  
Vol 11 ◽  
Author(s):  
Ann L. Arulappen ◽  
Monica Danial ◽  
Norliza Haron ◽  
Lim Choo Hau ◽  
Amer Hayat Khan
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Prophylaxis ◽  
Cost Savings ◽  
Surgical Site Infections ◽  
Defined Daily Dose ◽  
Prescribing Pattern ◽  
Healthcare Settings ◽  
Stewardship Program ◽  
The Cost ◽  
The Impact

Antimicrobial stewardship (AMS) program promotes the judicious use of antimicrobials. Hence, this study was conducted to analyze the impact of stewardship on the prescribing pattern of cefuroxime injection among the surgeons as perioperative antimicrobial prophylaxis (PAP). This study was conducted retrospectively in Malaysia. Various outcomes were measured including cefuroxime usage, compliance with the guidelines, surgical site infections, and cost savings. A total of 1,601 patients were recruited in the study. In terms of usage, the total defined daily dose (DDD) prior to the intervention was 202 DDD/100 procedures compared to that after intervention which was 144 DDD/100 procedures (p &lt; 0.05). On the other hand, the excessively long administration of PAP dropped from 94.4 to 30.3% (p &lt; 0.001). Focusing on the compliance with the newly developed local guidelines, it has increased from 53 to 94.3% after the interventions were made (p &lt; 0.001), whereas the rate of surgical site infections was reduced from 17.0 to 9.0%. The cost of antibiotic being used has significantly reduced after the study intervention (p = 0.007). The quality of PAP directly impacts the antimicrobial usage, the surgical site infections, and the total cost involved. Thus, it is crucial to maintain the standard of PAP at all times in healthcare settings.

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document