Multilayer model of pharmacy participation in the antimicrobial stewardship program at a large academic medical center Journal Article

Authors: Dubrovskaya, Y.; Scipione, M. R.; Siegfried, J.; Jen, S. P.; Pham, V.; Papadopoulos, J.; Decano, A.; Lewis, T.; Dabestani, A.
Article Title: Multilayer model of pharmacy participation in the antimicrobial stewardship program at a large academic medical center
Abstract: Purpose: 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. Summary: 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; P = 1.0). Ceftriaxone use increased by 8.4 DOT/1000 PD (P = .029) without a significant compensatory increase in the use of antipseudomonal agents. Sustained low rates of hospital-onset Clostridium difficile (CDI) and carbapenem-resistant Enterobacteriaceae (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% (P = .019). Conclusions: 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. © The Author(s) 2017.
Keywords: major clinical study; outcome assessment; drug hypersensitivity; health program; patient care; antiinfective agent; ciprofloxacin; drug monitoring; hospital readmission; hospital infection; linezolid; vancomycin; university hospital; drug utilization; azithromycin; levofloxacin; metronidazole; quinoline derived antiinfective agent; micafungin; drug use; ceftriaxone; piperacillin plus tazobactam; antimicrobial therapy; cefepime; interventions; daptomycin; oxacillin; meropenem; aminoglycoside antibiotic agent; imipenem; pharmacy; ertapenem; antimicrobial stewardship program; human; article; peptoclostridium difficile; carbapenem resistant enterobacteriaceae; antimicrobial utilization; ceftaroline; nafcillin; clinical audit; clinical pharmacy
Journal Title: Hospital Pharmacy
Volume: 52
Issue: 9
ISSN: 0018-5787
Publisher: Sage Publications  
Date Published: 2017-10-01
Start Page: 628
End Page: 634
Language: English
DOI: 10.1177/0018578717726993
PROVIDER: scopus
PMCID: PMC5735737
PUBMED: 29276300
Notes: Article -- Export Date: 4 December 2017 -- Source: Scopus
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