Development and implementation of “handshake rounds”: An antibiotic stewardship intervention for hospitalized adult patients with hematologic malignancies

Abstract

Objective: To design and implement “handshake rounds” as an antibiotic stewardship intervention to reduce inpatient intravenous (IV) antibiotic use in patients with hematologic malignancies. Design: Quasi-experimental analysis of antibiotic use (AU) and secondary outcomes before and and after handshake rounds were implemented. Setting: Quaternary-care, academic medical center. Patients: Hospitalized adults with hematologic malignancies receiving IV antibiotics. Methods: We performed a retrospective review of a preintervention cohort prior to the intervention. A multidisciplinary team developed criteria for de-escalation of antibiotics, logistics of handshake rounds, and outcome metrics. Eligible patients were discussed during scheduled handshake rounds between a hematology–oncology pharmacist and transplant–infectious diseases (TID) physician. Prospective data were collected over 30 days in the postintervention cohort. Due to small sample size, 2:1 matching was used to compare pre- to and postintervention AU. Total AU in days of therapy per 1,000 patient days (DOT/1,000 PD) was reported. Mean AU per patient was analyzed using Wilcoxon rank-sum test. A descriptive analysis of secondary outcomes of pre- and postintervention cohorts was performed. Results: Total AU was substantially lower after the intervention, with 517 DOT/1,000 PD compared to 865 DOT/1,000 PD before the intervention. There was no statistically significant difference in the mean AU per patient between the 2 cohorts. There was a lower rate of 30-day mortality in the postintervention cohort and rates of ICU admissions were similar. Conclusions: Conducting handshake rounds is a safe and effective way to implement an antibiotic stewardship intervention among high-risk patient population such as those with hematologic malignancies.

Mixed methods evaluation of handshake antimicrobial stewardship on adult inpatient medicine floors

“… 4 – 6 Outside of intensive care units, there are some data supporting the use of “high intensity” or “academic detailing” strategies, similar to handshake stewardship, to reduce broad-spectrum antimicrobial use, but there are limited data on the applicability of this strategy more broadly in adult hospitals. 7 – 9 …”

“…[4][5][6] Outside of intensive care units, there are some data supporting the use of "high intensity" or "academic detailing" strategies, similar to handshake stewardship, to reduce broad-spectrum antimicrobial use, but there are limited data on the applicability of this strategy more broadly in adult hospitals. [7][8][9] Considering workload volume and engagement of key stakeholders, our antimicrobial stewardship program implemented handshake stewardship rounds in patients admitted to medicine floors. The purpose of this study was to describe the implementation of our service and evaluate its impact on antimicrobial use.…”