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 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.

scholarly journals 965. Advanced Practice Providers in Infectious Disease: Educational Needs and Opportunities

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S574-S575
Author(s):  
Leah H Yoke ◽  
Alison M Beieler ◽  
Catherine Liu ◽  
Steven A Pergam ◽  
Steven A Pergam ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Clinical Trial ◽  
Interprofessional Collaboration ◽  
Educational Needs ◽  
Educational Opportunities ◽  
Alternative Methods ◽  
Advanced Practice ◽  
Material Support ◽  
Team Members ◽  
Certificate Programs

Abstract Background Advanced Practice Providers (APPs) practice throughout Infectious Disease (ID) in a variety of settings through interprofessional collaboration with physicians, pharmacists, and other team members. However, there is a paucity of specific and directed educational opportunities available for APPs within ID. In order to better understand this, we examined specific APP educational needs and how educational programs could provide high quality opportunities for APPs in ID. Methods Voluntary anonymous surveys were created in the REDCap data tool and distributed by email lists, social media, and Infectious Diseases Society of America community forums to APPs working in ID. Results Ninety-nine APPs responded to the survey (figure 1). 97% (96) of respondents were interested in APP specific ID educational opportunities. Of respondents, 76% (74) felt ID specific podcasts would be most helpful, while 86% (84) noted that access to ID clinical case conferences or self-directed, online modules would be instructive (figure 2). 91% (90) did not attend IDWeek annually due to various barriers, including lack of clinical coverage and cost associated with the conference (figure 3) despite 89% (88) receiving Continuing Education (CE) reimbursement. 64% (62) respondents were interested in future APP mentorship opportunities, from either more senior APPs or physicians. Figure 1. Geographic Distribution of Respondents, n=99 Conclusion APPs provide collaborative and specialized ID care in a variety of settings. However, continued educational needs specifically for APPs have been identified. From survey respondents, the majority of APPs did not attend IDWeek, a sentinel ID education event, citing clinical coverage and cost being significant barriers. This represents an opportunity for clinically focused educational opportunities, both at IDWeek and also through other platforms, particularly since many APPs receive CE funding from their employers. Podcasts, online lecture series, and self-study certificate programs were identified as avenues for ID teaching and also present accessible, alternative methods for training. Ultimately, as the growing APP workforce continues to provide patient care in a variety of ID settings, educational opportunities with mentorship are necessary to support them in their practice. Disclosures Steven A. Pergam, MD, MPH, Chimerix Inc. (Other Financial or Material Support, Clinical Trial)Global Life Technologies, Inc. (Grant/Research Support)Merck and Co. (Other Financial or Material Support, Clinical Trial) Steven A. Pergam, MD, MPH, Chimerix (Individual(s) Involved: Self): Clinical Trial; Global Life Technologies, Inc (Individual(s) Involved: Self): Research Grant or Support; Merck & Co. (Individual(s) Involved: Self): Scientific Research Study Investigator; Sanofi Aventis (Individual(s) Involved: Self): Other Financial or Material Support, Provided vaccines for clinical trial sponsored by the NIH

scholarly journals 164. Avoiding Complacency: Assessing the Perceived Impact and Value of Antimicrobial Stewardship at a Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S90-S91
Author(s):  
Matthew S Lee ◽  
Christopher McCoy
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Team Members ◽  
Academic Medical ◽  
Support Tools ◽  
Educational Engagement ◽  
Similar Survey ◽  
Perceived Impact

Abstract Background Multi-disciplinary engagement and education remain key measures for Antimicrobial Stewardship Programs (ASPs). Over 3 years, our ASP has undergone key changes to pre-authorization review, post-prescriptive activities, and core team members, coinciding with a 30% increase in stewardship interventions. The objectives of this study were to evaluate the familiarity of Nursing, Pharmacy and Prescribers at our academic medical center regarding ASP activities and services, as well as perceived impact on patient care and value. Secondary objectives were to determine what resources are currently utilized and areas for improvement. Methods Distinct surveys were distributed to three participant groups: Nurses, Pharmacists, and Prescribers (Housestaff, Advanced Practice Providers, and staff physicians). Questions were developed to assess familiarity, perceived value, and overall satisfaction with the ASP. Additional items included questions on the current use of ASP resources and educational engagement. Survey results were compared to a similar survey conducted 3 years amongst the same participant groups. Results The survey was delivered electronically to 3367 Prescribers, Nurses and Pharmacists. 403 responders completed the survey (208 Nurses, 181 Prescribers, and 18 Pharmacists). Familiarity was lowest amongst Nurses, but almost doubled compared to 2016 (Figure). Prescribers cited “restricted antibiotic approval”, “de-escalation”, and “alternative therapies relative to allergies” as the three most common interaction types, similar to 2016. ASP interactions continued to be rated “moderate” or “high” value (88.4% vs 89.15% in 2016), however, face-to-face interactions were preferred by only 4% of responders (unchanged compared to 2016). Prescribers also responded uncommon use of ASP online resources (20%) and clinical decision support tools (34%). 78% of responders expressed desire for increased ASP-related education. Conclusion As ASPs evolve, it is important to constantly evaluate impact and value, and identify areas for growth. Despite ASP familiarity being high and interactions valued, we need to further optimize ASP provided resources, clinical support tools, and educational offerings. Disclosures All Authors: No reported disclosures

71 Developing A Portfolio for Advanced Practitioners Working with Older People

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
L MacDiarmid
Keyword(s):  
Action Research ◽  
Older People ◽  
Nurse Practitioners ◽  
Professional Competence ◽  
Written Feedback ◽  
Advanced Practice ◽  
Participatory Action ◽  
Advanced Level ◽  
Team Members ◽  
Acute Trust

Abstract Introduction Advanced Nurse Practitioners (ANP’s) have a professional responsibility to ensure that they maintain professional competence (Whiteing, N. in Hinchcliffe and Rogers Eds pp192–219, 2008). The aim of the portfolio is to assist ANP’s in developing evidence demonstrating continued advanced level practice. At the time of the study, there was a dearth of evidence relating to competencies for qualified ANP’s, working with older people. The aim was to move away from the traditional confines of “nurse does this, doctor does this”, and to embrace the concept of developing skills to meet the clinical demands of service provision for our older people. Methods Participatory action research methodology was adopted—using the Review, Plan and act cycle (Edwards and Talbot, p63 1999; Holloway & Wheeler p155–156, 1996). Review A literature search and review of competencies relating to advanced practice and older people was undertaken. Plan A portfolio of knowledge and skills was collated utilising the information from the review. A matrix was created incorporating four Pillars of Advanced Practice (SGHD 2008), the Nursing and Midwifery Code (NMC, 2015) and modified competencies for Joint Royal Colleges of Physicians Training Board Geriatric curriculum (JRCPTB), (2010, amended 2013 and 2015). The portfolio was sent out to existing team members, and local Consultant Geriatricians based in the Acute Trust and local University for comment and amendments were made. Act The portfolio was used by staff as a trial and evaluated. Written feedback was obtained through questionnaires. Results The portfolio was well evaluated by staff using it, including recommendations for improvement. Portfolio has been shared at national groups and via social media and has been well received. Conclusions An Advanced Practice Portfolio of capabilities is being used, based on action research cycles, enhancing the level of care received by older people.

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 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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