Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center

Abstract

Leveraging pharmacy personnel resources for the purpose of antimicrobial stewardship program (ASP) operations presents a challenging task. We describe our experience integrating all pharmacists into an ASP, and evaluate the impact on ASP interventions, antimicrobial utilization, rate of selected hospital-onset infections and readmission. During a study period (January 1 to December 31, 2015), a total of 14 552 ASP-related pharmacy interventions were performed (ASP clinical pharmacotherapy specialists [CPS] n = 4025; non-ASP CPS n = 4888; hospital pharmacists n = 5639). Sixty percent of interventions by ASP CPS were initiated utilizing the dedicated ASP phone, and 40% through prospective audit and feedback. Non-ASP CPS performed interventions during bedside rounds (dose adjustment 23%, initiate new or alternative anti-infective 21%, discontinue antibiotic(s) 12%, therapeutic drug monitoring 11%, de-escalation 4%), whereas hospital pharmacists participated at the point of verification (dose adjustment 75%, restricted antibiotic verification 15%, and reporting major drug-drug interactions 4%). The acceptance rate of interventions by providers and clinicians was>90% for all groups. Annual aggregate antimicrobial use decreased by 6.4 days of therapy/1000 patient-days (DOT/1000 PD; = 1.0). Ceftriaxone use increased by 8.4 DOT/1000 PD ( = .029) without a significant compensatory increase in the use of antipseudomonal agents. Sustained low rates of hospital-onset (CDI) and carbapenem-resistant (CRE) infections were observed in 2015 compared with the prior year (1.1 and 1.2 cases/1000 PD, 0.2 and 0.1 cases/1000 PD, respectively). Thirty-day readmission rate decreased by 0.6% ( = .019). Integration of all pharmacists into ASP activities based on the level of patient care and responsibilities is an effective strategy to expand clinical services provided by ASP.

Antimicrobial stewardship effectiveness on rationalizing the use of last line of antibiotics in a short period with limited human resources: a single centre cohort study

“…In addition, this was also in accordance with final step of A-team intervention, which consisted of dispensing AR from hospital pharmacy only after validation from clinical pharmacist with access to medical record. Improving antimicrobial prescribing by clinical pharmacist is in correlation with previous studies and guidelines [25-27]. Multidisciplinary approach has proved to be beneficial in this study for understanding the A-team interventions and therefore accomplishing primary outcomes.…”

Use of Monitoring Indicators in Hospital Management of Antimicrobials

“…The time of use of quinolones (4.7 DOT / 1000pd) and carbapenems (13.5 DOT / 1000pd) were well below the values veri ed in this study. However, studies show results ranging from 25.8 DOT / 1000pd to 132.3 DOT / 1000pd for quinolones and 8.7 DOT / 1000pd to 39.1 DOT / 1000pd for carbapenems [2,9,10], this variation may be related to the lack of uniformity in data collection, which implies the importance of standardizing the obtainment of these rates, allowing reliable comparability of the data.…”

Application of Monitoring Indicators in The Management of Hospital Use of Antimicrobials

“…The time of use of quinolones (4.7 DOT / 1000pd) and carbapenems (13.5 DOT / 1000pd) were well below the values verified in this study. However, studies show results ranging from 25.8 DOT / 1000pd to 132.3 DOT / 1000pd for quinolones and 8.7 DOT / 1000pd to 39.1 DOT / 1000pd for carbapenems [2,9,10], this variation may be related to the lack of uniformity in data collection, which implies the importance of standardizing the obtainment of these rates, allowing reliable comparability of the data.…”

“…In view of the above, the Centers for Disease Control and the World Health Organization, together with the United Nations member countries, including Brazil, have been encouraging the implementation of programs such as the "Antimicrobial Stewardship Program", which is a set of interventions, audits and feedbacks, in order to optimize the use of ATMs [2,3,9,10]. Recently, in July 2019, the National Health Surveillance Agency launched the "Brazil Stewardship Project" [6], in order to assess the national panorama of antimicrobial use management programs, encouraging managers to implement antimicrobial use management programs, with publication of the results, enabling the confrontation of national data.…”