scholarly journals A Retroprospective Study of an Antimicrobial Stewardship Program on Antimicrobial Utilization at a Tertiary Care Medical Center in Kolkata

2021 ◽  
Vol 70 (2) ◽  
Author(s):  
Sujay Ranjan Deb ◽  
Sourav Maiti ◽  
Arpan Dutta Roy ◽  
Prolay Paul ◽  
Dipankar Maiti ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Population Based ◽  
Defined Daily Dose ◽  
Stewardship Program ◽  
Tertiary Care Medical Center ◽  
Antimicrobial Utilization ◽  
Daily Dose ◽  
Clinically Significant

The WHO has set Defined Daily Dose which represent the average daily dose of an antibiotic in a standard patient. The DDD mainly focuses on population-based parameters & assumes that patients as well as hospitals are homogenous entities. DOTs are very useful in order to classify antibiotic days based on patient-level exposure. DOTs merely mean the number of days that a patient is on an antibiotic, irrespective of dose. DOTs signifies that the underlying assumptions about antibiotic dosing was appropriate. Additionally, when patients receive more than one antibiotic, supplementary DOT may be counted. The 300-bed tertiary care medical center serves adults and paediatrics. An all-time Microbiology Consultant and a Clinical Pharmacology trainee used to go for round daily and used to collect data for ASP for the period of 3 months that is April to June,2021. In this study we have compared DOT of some important antibiotics for a specific period of time for both COVID and NON COVID patient. ASP-focused antibiotics were antibiotics routinely evaluated by the ASP team for appropriateness during therapy and the potential to optimize their appropriate use through policies, protocols, formulary restrictions, or clinician education. ASP-focused antibiotics included meropenem, linezolid, pip-taz, poly b, colistin, teicoplanin. In this study we have compared the DDD for 2 specific period of time for better understanding the consumption of those antibiotics. In conclusion, following the initiation of an ASP, significant decreases in utilization, increases in cost savings occurred. In our study we have reduced the consumption and DDD of linezolid which is clinically significant. When it comes to DOTs; We have reduced the DOTs of piptaz and teicoplanin for covid patient And Reduced the DOTs of meropenem and teicoplanin for noncovid patient which is clinically and statistically significant.

Usefulness of a Rapid Human Immunodeficiency Virus-1 Antibody Test for the Management of Occupational Exposure to Blood and Body Fluid

2005 ◽  
Vol 26 (9) ◽  
pp. 768-774 ◽  
Author(s):  
Michael L. Landrum ◽  
Clarissa H. Wilson ◽  
Luci P. Perii ◽  
Sandra L. Hannibal ◽  
Robert J. O'Connell
Keyword(s):  
Occupational Exposure ◽  
Medical Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Occupational Exposures ◽  
Antibody Test ◽  
Stress Reaction ◽  
Post Exposure Prophylaxis ◽  
Potential Cost ◽  
Tertiary Care Medical Center

AbstractObjective:To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms.Design:Before-and-after analysis.Setting:A 269-bed, tertiary-care medical center with adjacent clinics.Participants:All source-patients and HCWs experiencing an occupational exposure during the study period.Methods:Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms.Results:After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of $6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P= .049).Conclusion:Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HJV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.

Incidence of interruptive penicillin allergy alerts in patients with previously documented beta-lactam exposure: Potential for leveraging the electronic health record to identify erroneous allergies

2021 ◽  
pp. 1-4
Author(s):  
Nicole Van Groningen ◽  
Ray Duncan ◽  
Galen Cook-Wiens ◽  
Aaron Kwong ◽  
Matthew Sonesen ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Medical Center ◽  
Tertiary Care ◽  
Penicillin Allergy ◽  
Health Record ◽  
Beta Lactam ◽  
Tertiary Care Medical Center ◽  
Lactam Antibiotic ◽  
Electronic Health ◽  
Clinically Significant

Abstract Background: Approximately 10% of patients report allergies to penicillin, yet >90% of these allergies are not clinically significant. Patients reporting penicillin allergies are often treated with second-line, non–β-lactam antibiotics that are typically broader spectrum and more toxic. Orders for β-lactam antibiotics for these patients trigger interruptive alerts, even when there is electronic health record (EHR) data indicating prior β-lactam exposure. Objective: To describe the rate that interruptive penicillin allergy alerts display for patients who have previously had a β-lactam exposure. Design: Retrospective EHR review from January 2013 through June 2018. Setting: A nonprofit health system including 1 large tertiary-care medical center, a smaller associated hospital, 2 emergency departments, and ˜250 outpatient clinics. Participants: All patients with EHR-documented of penicillin allergies. Methods: We examined interruptive penicillin allergy alerts and identified the number and percentage of alerts that display for patients with a prior administration of a penicillin class or other β-lactam antibiotic. Results: Of 115,081 allergy alerts that displayed during the study period, 8% were displayed for patients who had an inpatient administration of a penicillin antibiotic after the allergy was noted, and 49% were displayed for patients with a prior inpatient administration of any β-lactam. Conclusions: Many interruptive penicillin allergy alerts display for patients who would likely tolerate a penicillin, and half of all alerts display for patients who would likely tolerate another β-lactam.

scholarly journals Evaluation of Albumin 25% Use in Critically Ill Patients at a Tertiary Care Medical Center

2019 ◽  
Vol 55 (2) ◽  
pp. 90-95
Author(s):  
Heather Torbic ◽  
Seth R. Bauer ◽  
Michael Militello ◽  
Sarah Welch ◽  
Chiedozie Udeh ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cleveland Clinic ◽  
Cost Savings ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Total Cost ◽  
Tertiary Care Medical Center ◽  
Primary Literature

Background: Albumin 25% has been studied and has demonstrated benefit in a limited number of patient populations. The use of albumin 25% is associated with higher costs compared with crystalloid therapy. The aim of this study was to describe the prescribing practices of albumin 25% at a tertiary-care medical center and identify opportunities for restriction criteria related to its use to help generate cost savings. Methods: This evaluation was a retrospective, noninterventional, descriptive study of albumin 25% use between June 2015 and February 2016. Inclusion criteria consisted of patients ≥18 years old and who received at least one dose of albumin 25% while admitted to a Cleveland Clinic main campus intensive care unit (ICU). Inclusion was restricted to 150 randomly selected patients. Results: A total of 539 albumin 25% orders were placed for the 150 included patients. The cardiovascular ICU more frequently prescribed albumin 25% compared with the medical, surgical, neurosciences, and coronary ICUs (51% vs 23% vs 11% vs 9% vs 6%, respectively). Although the cardiovascular surgery ICU most frequently prescribed albumin 25% compared with other ICUs, the medical ICU prescribed a larger total quantity of albumin 25% compared with the cardiovascular, surgical, neurosciences, and coronary ICUs (8705 g vs 7275 g vs 3205 g vs 2162 g vs 625 g, respectively). The majority of patients (61%) did not have an indication listed for albumin 25% use and only 9% of patients were prescribed for indications supported by primary literature. Of the patients prescribed albumin for other indications not supported by primary literature (30%), the most common reasons for albumin 25% were hypotension, acute kidney injury, and volume resuscitation. The median cost per patient of albumin 25% was $417 with a total cost of $122 164 for the cohort. Only 19% of the total cost aligned with dosing regimens evaluated in primary literature. Conclusion: Prescribing patterns of albumin 25% at a tertiary academic medical center do not align with indications supported by primary literature. These findings identified a major opportunity for prescriber education and implementation of restriction criteria to target cost savings.

Chlorpropamide-Induced Hyponatremia in the Veteran Population

1992 ◽  
Vol 26 (10) ◽  
pp. 1243-1244 ◽  
Author(s):  
Catherine A. Hirokawa ◽  
David R. Gray
Keyword(s):  
Serum Sodium ◽  
Ace Inhibitor ◽  
Medical Center ◽  
Tertiary Care ◽  
Sodium Concentration ◽  
Control Group ◽  
Predisposing Factor ◽  
The Past ◽  
Tertiary Care Medical Center ◽  
Daily Dose

OBJECTIVE: To determine the incidence and possible risk factors associated with chlorpropamide (CPA)-induced hyponatremia in the veteran population. DESIGN: Retrospective cohort study. SETTING: Federal tertiary care medical center. PATIENTS: Veterans receiving CPA from our facility with at least one serum sodium concentration below 135 mmol/L within the past year were eligible. A randomly selected control group consisting of patients taking CPA with normal sodium concentrations was also chosen. One hundred forty-five of 799 patients who had received CPA were included in the study. RESULTS: The average daily dose of CPA was 425 ± 207 mg (± SD). The incidence of hyponatremia associated with CPA was 7.1 percent (57/799 patients). The majority of patients were mildly hyponatremic (48/57 patients, 84 percent) with serum sodium concentrations between 130 and 134 mmol/L. The incidence of CPA-induced syndrome of inappropriate antidiuretic hormone was 2.1 percent. Concurrent angiotensin-converting enzyme (ACE) inhibitor use was identified as a risk factor; thiazide diuretic use was not. CONCLUSIONS: The incidence of hyponatremia related to CPA use in elderly veterans is consistent with other reports in the literature. ACE inhibitors may be a predisposing factor for CPA-induced hyponatremia.

scholarly journals Trend analysis of antibiotics consumption using WHO AWaRe classification in tertiary care hospital

2020 ◽  
Vol 9 (11) ◽  
pp. 1675
Author(s):  
Ankit Bhardwaj ◽  
Kaveri Kapoor ◽  
Vivek Singh
Keyword(s):  
Infectious Diseases ◽  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Consumption Pattern ◽  
P Value ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Stewardship Program ◽  
Daily Dose

Background: Aim of the study was to assess trend in antibiotics consumption pattern from 2016 to 2019 using AWaRe classification, ATC and Defined daily dose methodology (DDD) in a tertiary care hospital. Antibiotics are crucial for treating infectious diseases and have significantly improved the prognosis of patients with infectious diseases, reducing morbidity and mortality. The aim of the study is to classify the antibiotic based on WHO AWaRe classification and compare their four-year consumption trends. The study was conducted at a tertiary care center, Pilakhuwa, Hapur. Antibiotic procurement data for a period of 4 years (2016-2019) was collected from the Central medical store.Methods: This is a retrospective time series analysis of systemic antibiotics with no intervention at patient level. Antibiotic procurement was taken as proxy for consumption assuming that same has been used.  ATC for systemic use (ATC code J01) antibacterial was used and defined daily dose (DDD) per 100 bed days was calculated. Antibiotics were further classified as Access, Watch, and Reserve (WHO AWaRe classification).  Antibiotics consumption was ranked based on their volume of DDD i.e., drug utilization (DU90%) was calculated. Non-parametric Pearson’s correlation coefficient was used for the comparison of consumption.Results: Mean antibiotic procurement increased 1.25 folds from 140.3 DDD in 2016 to 201 DDD in 2018. A significant fall was seen in total DDDs in year 2019 (p value <0.05). A total of 41 antibiotics agents (Access 12, Watch 21, Reserve 6 and Not recommended 2) were procured. Reserve category antibiotics were procured from 2017 onwards. Out of 41 antibiotics procured 11 antibiotics (Access 3 and watch 8) accounted for DU 90%.Conclusions: Antibiotics consumption of watch group was high and increasing antibiotic consumption trend was observed. Hospital antimicrobial stewardship program should be implemented to shift to use of Access group antibiotics and restrict use of Watch antibiotics.

scholarly journals Prevalence and Predictors of Compliance with Discontinuation of Airborne Isolation in Patients with Suspected Pulmonary Tuberculosis

2013 ◽  
Vol 34 (9) ◽  
pp. 967-972 ◽  
Author(s):  
Benjamin S. Thomas ◽  
Erlaine F. Bello ◽  
Todd B. Seto
Keyword(s):  
Standard Deviation ◽  
Pulmonary Tuberculosis ◽  
Medical Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Private University ◽  
Tertiary Care Medical Center ◽  
Cdc Guidelines ◽  
Control And Prevention ◽  
Male Sex

Objective.Examine the use of airborne isolation by identifying reasons for nontimely discontinuation and predictors of compliance with Centers for Disease Control and Prevention (CDC) guidelines. Compliance with guidelines should result in timely (within 48 hours) discontinuation of isolation in patients without infectious pulmonary tuberculosis (TB).Design.Retrospective, observational study.Setting.A private, university-affiliated, tertiary-care medical center.Patients.All patients in airborne isolation for suspected pulmonary TB from June through December 2011.Method.Chart reviews were performed to identify airborne isolation practices and delayed (greater than 48 hours) or very delayed (greater than 72 hours) discontinuation. We used descriptive statistics and logistic regression to determine independent predictors of nontimely discontinuation of isolation.Results.We identified 113 patients (mean age ± standard deviation, 59.8 ± 17.7 years; male sex, 75.2%; white race, 15.9%; mean collection interval ± standard deviation, 21.4 ± 12.9 hours). Delayed and very delayed isolation discontinuation was noted in 81% and 49% of patients, respectively. No significant differences in demographic characteristics and clinical characteristics were identified between groups. Predictors of timely (within 48 hours) airborne isolation discontinuation included use of alternate diagnosis for discontinuation of isolation (P = .02), early infectious diseases (ID) consultation (P = .03), pulmonary consultation (P = .02), average sputum collection interval less than 24 hours (P = .03), and need for more than 1 induced sputum specimen (P = .05). Adjusting for potential confounders, pulmonary consultation (odds ratio [OR] [95% confidence interval (CI)], 0.14 [0.03-0.58]), alternate diagnosis for discontinuation of isolation (OR [95% CI], 4.5 [1.3-15.8]), and early ID consultation (OR [95% CI], 4.0 [1.1-14.8]) were independently associated with timely discontinuation.Conclusions.Timely airborne isolation discontinuation occurs in only 18.6% of cases and is an opportunity for cost savings, improved efficiency, and potentially patient safety and satisfaction.

Comparative Assessment of Antimicrobial Usage Measures in the Department of Veterans Affairs

2012 ◽  
Vol 33 (4) ◽  
pp. 409-411 ◽  
Author(s):  
Patricia L. Schirmer ◽  
Renee C. Mercier ◽  
Russell A. Ryono ◽  
Nancy Nguyen ◽  
Cynthia A. Lucero ◽  
...  
Keyword(s):  
Medical Center ◽  
Medication Administration ◽  
Veterans Affairs ◽  
Comparative Assessment ◽  
Data Sources ◽  
Defined Daily Dose ◽  
Department Of Veterans Affairs ◽  
Antimicrobial Utilization ◽  
Days Of Therapy ◽  
Daily Dose

We compared 2 data sources—antimicrobial orders and bar-coded medication administration (BCMA)—for calculating the number of grams used, grams used based on defined daily dose, and days of therapy at one Veterans Affairs Medical Center for 2009-2010. The number of grams used calculated from BCMA data provided the most informative antimicrobial utilization measure.

scholarly journals EVALUATION OF FACTORS ASSOCIATED WITH MORTALITY AMONGST PATIENTS ADMITTED TO A TERTIARY CARE MEDICAL CENTER FOR COVID-19 INFECTION

2021 ◽  
Vol 77 (18) ◽  
pp. 3123
Author(s):  
Anish Samuel ◽  
Ashesha Mechineni ◽  
Robin Craven ◽  
Wilbert Aronow ◽  
Mourad Ismail ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Factors Associated ◽  
Tertiary Care Medical Center

scholarly journals Implementation of a Resource-Efficient Indirect Handshake Stewardship Model at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s272-s272
Author(s):  
Ronald Beaulieu ◽  
Milner Staub ◽  
Thomas Talbot ◽  
Matthew Greene ◽  
Gowri Satyanarayana ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Antibiotic Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Communication Model ◽  
Contributing Factors ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Data Feedback ◽  
Days Of Therapy

Background: Handshake antibiotic stewardship is an effective but resource-intensive strategy for reducing antimicrobial utilization. At larger hospitals, widespread implementation of direct handshake rounds may be constrained by available resources. To optimize resource utilization and mirror handshake antimicrobial stewardship, we designed an indirect feedback model utilizing existing team pharmacy infrastructure. Methods: The antibiotic stewardship program (ASP) utilized the plan-do-study-act (PDSA) improvement methodology to implement an antibiotic stewardship intervention centered on antimicrobial utilization feedback and patient-level recommendations to optimize antimicrobial utilization. The intervention included team-based antimicrobial utilization dashboard development, biweekly antimicrobial utilization data feedback of total antimicrobial utilization and select drug-specific antimicrobial utilization, and twice weekly individualized review by ASP staff of all patients admitted to the 5 hospitalist teams on antimicrobials with recommendations (discontinuation, optimization, etc) relayed electronically to team-based pharmacists. Pharmacists were to communicate recommendations as an indirect surrogate for handshake antibiotic stewardship. As reviewer duties expanded to include a rotation of multiple reviewers, a standard operating procedure was created. A closed-loop communication model was developed to ensure pharmacist feedback receipt and to allow intervention acceptance tracking. During implementation optimization, a team pharmacist-champion was identified and addressed communication lapses. An outcome measure of days of therapy per 1,000 patient days present (DOT/1,000 PD) and balance measure of in-hospital mortality were chosen. Implementation began April 5, 2019, and data were collected through October 31, 2019. Preintervention comparison data spanned December 2017 to April 2019. Results: Overall, 1,119 cases were reviewed by the ASP, of whom 255 (22.8%) received feedback. In total, 236 of 362 recommendations (65.2%) were implemented (Fig. 1). Antimicrobial discontinuation was the most frequent (147 of 362, 40.6%), and most consistently implemented (111 of 147, 75.3%), recommendation. The DOT/1,000 PD before the intervention compared to the same metric after intervention remained unchanged (741.1 vs 725.4; P = .60) as did crude in-hospital mortality (1.8% vs 1.7%; P = .76). Several contributing factors were identified: communication lapses (eg, emails not received by 2 pharmacists), intervention timing (mismatch of recommendation and rounding window), and individual culture (some pharmacists with reduced buy-in selectively relayed recommendations). Conclusion: Although resource efficient, this model of indirect handshake did not significantly impact total antimicrobial utilization. Through serial PDSA cycles, implementation barriers were identified that can be addressed to improve the feedback process. Communication, expectation management, and interpersonal relationship development emerged as critical issues contributing to poor recommendation adherence. Future PDSA cycles will focus on streamlining processes to improve communication among stakeholders.Funding: NoneDisclosures: None

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