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.

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 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

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 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.

scholarly journals Impact of a multifaceted antimicrobial stewardship program: A front-line ownership driven quality improvement project in a large urban emergency department

CJEM ◽  
2017 ◽  
Vol 19 (06) ◽  
pp. 441-449 ◽  
Author(s):  
Adam Jonathan Kaufman ◽  
Janine McCready ◽  
Jeff Powis
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Inpatient Setting ◽  
Successful Implementation ◽  
Antimicrobial Use ◽  
Front Line ◽  
Improvement Project ◽  
Antibiotic Overuse ◽  
Defined Daily Doses ◽  
Stewardship Program

AbstractBackgroundAntibiotic overuse has promoted growing rates of antimicrobial resistance and secondary antibiotic-associated infections such asClostridium difficile(C. difficile). Antimicrobial stewardship programs (ASPs) are effective in reducing antimicrobial use in the inpatient setting; however, the unique environment of the emergency department (ED) lends itself to challenges for successful implementation. Front-line ownership (FLO) methodology has been shown to be a potentially effective strategy for the implementation of inpatient ASPs through an iterative multi-pronged approach driven by front-line providers.ObjectiveTo determine whether a FLO approach to antimicrobial stewardship in the ED can alter antimicrobial usage.MethodsInterventions were driven by ED physicians and facilitated by Infectious Diseases Division physicians from the hospital’s ASP using FLO principles. Measured end points included antibiotic usage in the ED as measured by defined daily doses, and rates of urine culture sent from the ED.ResultsThere was a step-wise significant reduction in the use of azithromycin (p=0.006), ceftriaxone (p=0.045), ciprofloxacin (p=0.034), and moxifloxacin (p=0.008). There was also a significant reduction in rates of urine cultures (p&lt;0.001) by 2.26 urine cultures per 100 ED patient visits.ConclusionsFLO offers a promising approach to successful implementation of an ASP in the ED. Future studies would be important to evaluate the generalizability of the FLO approach to ASP development in other EDs and to determine strategies to improve the sustainability of reductions in antimicrobial use.

scholarly journals Inaccurate Communications in Telephone Calls to an Antimicrobial Stewardship Program

2006 ◽  
Vol 27 (7) ◽  
pp. 688-694 ◽  
Author(s):  
Darren R. Linkin ◽  
Sarah Paris ◽  
Neil O. Fishman ◽  
Joshua P. Metlay ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Antimicrobial Stewardship ◽  
Odds Ratio ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Patient Data ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Prior Approval ◽  
Telephone Calls

Background.Antimicrobial stewardship programs (ASPs) decrease unnecessary antimicrobial use, decrease antimicrobial resistance, and improve patient outcomes. The effectiveness of a prior approval system—that is, the requirement that approval be obtained from ASP practitioners before certain antimicrobials can be used—depends on the accuracy of the patient data communicated from the primary service.Objectives.To determine the incidence of inaccurate communication of patient data during ASP interactions, describe examples of inaccurate communications, and identify risk factors for inaccurate communication.Design.We used a retrospective cohort design. We evaluated the communicated patient data for clinically important inaccuracies, using the patients' medical records as the gold standard.Setting.A tertiary care medical center that has a prior approval system for restricted antimicrobials.Patients.Inpatients discussed in telephone ASP interactions.Intervention.Observational study.Results.Of telephone calls requesting prior approval from ASP practitioners, 39% (95% confidence interval [CI], 31%-48%) contained an inaccuracy in at least 1 type of patient data (eg, current antimicrobial therapy); the incidence varied widely between data types. Examples of inaccuracies are given to demonstrate their clinical relevance. In multivariable analysis, inaccurate communications were more common for telephone calls from surgical services (versus calls from nonsurgical services: odds ratio, 2.1 [95% CI, 1.1-3.9]) and for calls received by Infectious Diseases fellows (versus pharmacists: odds ratio, 2.0 [95% CI, 1.1-3.8]).Conclusions.A high proportion of ASP calls requesting prior approval included patient data inaccuracies, which have the potential to affect the prescribing of antimicrobials. Although risk factors were identified, these communication errors were common across the different types of ASP interactions. Inaccurate communications may compromise the utility of ASPs that use a prior approval system for optimizing antimicrobial use.

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