The aim of the study was to evaluate the impact of a multifaceted antimicrobial stewardship intervention on antibiotic consumption in a primary health care (PHC) area in Spain. Quasi-experimental study conducted in a PHC area with nine PHC centers, a 400-bed acute care teaching hospital, and 18 nursing homes serving a population of 260,561. The intervention was based on the 2016 CDC Core Elements of Outpatient Antibiotic Stewardship publication and targeted 130 PHC physicians, 41 PHC pediatricians, 19 emergency physicians, and 18 nursing home physicians. The components were commitment, actions for improving antibiotic prescribing, tracking and feedback, and education and experience. The primary outcome was overall antibiotic consumption. Secondary outcomes were consumption of antibiotics to treat pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, and urinary tract infection (UTI), percentage of patients treated with specific antibiotics, and dispensing costs. Consumption was measured in defined daily doses per 1,000 inhabitants per day (DID) and compared pre-and postintervention (2016 vs. 2018). Overall antibiotic consumption decreased from 16.01 to 13.31 DID (−16.85%). Consumption of amoxicillin/clavulanic acid and quinolones decreased from 6.04 to 4.72 DID (−21.88%) and 1.64 to 1.23 DID (−25.06%), respectively. The percentage of patients treated with antibiotics decreased from 26.99 to 22.41%. The intervention resulted in cost savings of €72,673. Use of antibiotics to treat pharyngotonsillitis, UTI, and acute otitis media, sinusitis, and bronchitis decreased significantly. Our antimicrobial stewardship program led to a decrease in antibiotic consumption and significantly improved the use of antibiotics for the most prevalent PHC infections.

No abstract

One of the critical elements of antimicrobial stewardship programs is the ability to measure the quality of antibiotic prescriptions. The aims of the present study were to evaluate the performance properties of a set of previously developed quality indicators (QIs) and to identify the potential room for improvement in antibiotic use in our setting. A monthly cross-sectional point prevalence survey was conducted in a 400-bed acute care teaching hospital, from June to November 2015. All adult patients treated for ≥24 hours with antibiotic therapy for a suspected hospital- or community-acquired bacterial infection were included. Performance scores (adherence, room for improvement, interobserver reliability, and applicability) were calculated for 8 QIs. A total of 362 patients were evaluated. Adherence to the whole set of QIs was accomplished for 14.1% of evaluable patients. The QIs with greater room for improvement were adequate request for blood cultures (60.6%), therapeutic drug monitoring (TDM) (59.1%), sequential antibiotic therapy within 72 hours (48.2%), and empirical antibiotic therapy according to local guidelines (30.4%). The percentage of patients receiving unnecessary antibiotic treatment in the absence of clinical or microbiological evidence of infection after 5 days was 12.2%. All indicators scored kappa values of ≥0.6, suggesting good interobserver reliability. Low applicability (6.1% of reviewed patients) was found only for the TDM QI. The QIs analyzed were found to be applicable, showed good interobserver reliability, and were useful tools to identify areas with potential room for improvement in antibiotic use.

BACKGROUND: The ability to measure the quality of antibiotic prescriptions is a critical element in all antimicrobial stewardship programs. The aims of the present study were to evaluate the clinimetric properties of 32 recently developed outpatient quality indicators (OQIs) and to identify potential room for improvement in antibiotic use in a primary healthcare (PHC) area. METHODS: Study performed in a PHC area in Barcelona, Spain with 260,657 inhabitants, nine PHC centers, and a 400-bed acute care teaching. We selected nine of the 32 OQIs that were applicable to our PHC area and evaluated then for measurability, adherence, and room for improvement. Non-measurable OQIs, OQIs without room for improvement, and OQIs beyond the scope of the PHC antimicrobial stewardship program were excluded. RESULTS: Data from 260,561 registered patients were assessed. Measurability was high for all OQIs except those that required manual recording of the clinical diagnosis (OQIs on group A streptococcal diagnostic testing). Adherence to guidelines was poor for most OQIs but particularly the indicator on the avoidance of antibiotics for viral or self-limiting bacterial infections, where we observed more than 60% room for improvement for both acute tonsillitis and sinusitis. CONCLUSIONS: The QIs evaluated were applicable to clinical practice and proved useful for identifying areas with room for improvement in our setting and for guiding the design of future interventions with specific objectives.

2.8:1 to 6.3:1. (This does not include the 27% reduction in drug spend observed during the study period. However, more longitudinal data are required to confirm and characterise this phenomenon.). In the third quarter of 2018, 21 medication incidents were reported from the study ward compared with an average of 4 incident reports from the first and second quarters of 2018. This represents a fivefold increase in medication incident reporting, suggestive of an enhanced culture of patient safety. Conclusion and relevance This study assessed and quantified a wide spectrum of pharmacist contributions to medication management and safety. Costing of these contributions estimated the cost-benefit ratio of the clinical pharmacy service, providing compelling support for the extension of this service throughout the hospital.

No abstract

Background Since 2008, the economic crisis has directly affected many activities, health and biomedical research being particular fields involved. Purpose To evaluate the impact of the economic crisis on research at a Spanish hospital based on an analysis on the work done by the Clinical Research Ethics Committee (CEIC). To compare it with any effects on Spanish and European CTs. Materials and Methods CEIC Minutes from a 500-bed university hospital were reviewed from 2000 to 2011, obtaining information from clinical trials (CTs) and observational studies (OS). The financing of CTs was classified: 1) CTs promoted by the pharmaceutical industry, 2) by scientific societies with industry support, 3) by scientific societies with government support and 4) unfunded CTs. We compared two periods: pre-crisis (2000–2007) and crisis (2008–2011). National scientific activity was obtained from a secondary data source from the information provided by the Agencia Española de Medicamentos y Productos Sanitarios and the European activity from EU Clinical Trials Registers (European Medicines Agency website). Data analysis used conventional descriptive statistics. Results 782 protocols were evaluated (average 71 protocols/year). During 2008–2011 there was an annual average decrease of 13 CT in groups 1 and 2, compared with the period 2000–2007 (95% CI: 4–22 CT). Regarding the OSs, there was an annual average increase of 36 OSs during the second period (95% CI: 24–49 OS). There were no statistical differences between the two periods for groups 3 and 4. The total number of protocols increased by an average of 25 projects/year during the second period compared to the first (95% CI: 8–40 projects). There were 2340 CTs in Spain during the first period and 3096 during the second (p = ns). CTs in Europe were 7,908 and 10,632 respectively (p = ns). Conclusions The CEIC workload was maintained, even increased, but because of OSs and unfunded research. The crisis marked a turning point; funded studies decreased and OSs increased. At the moment there are no noteworthy changes in Spanish or European CT activity. Abstract OHP-047 Table 1 Number of CTs % Group 1 407 52 Group 2 53 7 Group 3 32 4 Group 4 93 12 OS 197 25 *OS were analysed globally No conflict of interest.

Background Medication reconciliation is a key point of security and improvement to patient care process. Purpose To describe discrepancies in medication reconciliation process during admission and classify drugs involved in reconciliation errors according to Anatomical Therapeutic Chemical (ATC) classification system. Materials and methods Prospective, longitudinal study performed from January to September 2011 in a 500-bed university hospital. The pharmacist assisted the emergency department 1 h a day and checked current home medication and emergency prescription. Patients who had programmed admission at that moment were included. Medication information prior to admission was collected from electronic clinical history and patients' interview. Identified discrepancies were commented to physicians to obtain explanation. If it was necessary prescription was filled or/and modified. Quality parameters (discrepancies/patient and errors/patient) and coverage ratio (patients reviewed/admitted) recommended by Sociedad Española de Farmacia Hospitalaria were calculated. GRP062 Table 1Main drug group implicated in reconciliation error Therapeutic group N % C 235 45.9 Antihypertensives 103 20.1 Hypolipidaemic 60 11.7 Diuretic 32 6.3 N 91 17.8 Antidepressive 34 6.6 Antiepileptics 18 3.5 BDZ 18 3.5 B 66 12.9 Antiplatelet 37 7.2 Oral anticoagulants 6 1.2 A 49 9.6 Oral antidiabetic 16 3.1 IBP 16 3.1 Others 71 13.9 Results 846 patients were included with an average age of 76 (limits: 34–97), 53.1% were men. Were identified 512 discrepancies in 274 patients (1.8 discrepancies/patient), 287 (56.1%) were not justified (considered reconciliation errors). Coverage ratio was 32.4%. A 63.5% (174) of patients presented at least one error (1.3 error/patient). The main error was incomplete prescription in a 30.1% (154), followed by current drug omission in 11.9% (61), different dose, administration route or frequency in 8.6% (44), wrong medication in 2.5% (13), duplicity 2.1% (11) and interaction in 0.6% (3) cases. Classifying discrepancies by ATC system, the C group presented the highest percentage with a 45.9% (235), the N group 17.8% (91), B 12.9% (66) and A 9.6% (49). The other groups represented 13.9% (71). Main drug group implicated in reconciliation error are detailed in table 1. Conclusions Medication reconciliation is an important multidisciplinary strategy conducted by pharmacists to improve security in hospitals. A high percentage of patients presented reconciliation errors so it could be necessary that sanitary staff take in consideration its importance.