Antibiotic assessment at hospital discharge—Room for stewardship intervention

Barnett, Susanne G.; Lata, Paul; Kavalier, Meredith; Crnich, Christopher; Balasubramanian, P.

doi:10.1017/ice.2019.332

Cited by 7 publications

(13 citation statements)

References 10 publications

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“…Initial findings suggest discharge stewardship is well received and associated with less frequent use of broad-spectrum antibiotics and shorter antibiotic durations following hospitalization. 21 , 22 Compared to both the Barnett and Yogo studies, we observed higher rates of pharmacist interventions at discharge (25% vs 9.7% and 23%, respectively) and higher acceptance of pharmacist recommendations (70% vs 58% and 67%, respectively). Possible contributors to this difference include the structured nature of our timeout, the prospective quality of the study, and an established stewardship role of pharmacists in our hospital system.…”

Section: Discussioncontrasting

confidence: 60%

“…Possible contributors to this difference include the structured nature of our timeout, the prospective quality of the study, and an established stewardship role of pharmacists in our hospital system. 21,22 Although our timeout led to frequent changes in discharge antibiotic prescriptions, no significant differences were observed in antibiotic use compared to the control. This lack of effect is likely multifactorial.…”

Section: Discussionmentioning

confidence: 81%

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Reducing overuse of antibiotics at discharge home: A single-center mixed methods pilot study

Giesler¹,

Krein²,

Brancaccio³

et al. 2022

American Journal of Infection Control

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Background: Antibiotic overuse at hospital discharge is common and harmful; however, methods to improve prescribing during care transitions have been understudied. We aimed to pilot a pharmacist-facilitated antibiotic timeout prior to discharge. Methods: From May 2019 to October 2019, we conducted a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to discharge. The timeout addressed key elements of stewardship (eg, duration) and was designed and implemented using iterative cycles with rapid feedback. We evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability, using mixed methods. Pre versus postintervention antibiotic use at discharge in intervention versus control groups was assessed using logistic regression models controlling for patient characteristics. Results: Pharmacists conducted 288 antibiotic timeouts. Timeouts were feasible (mean 2.5 minutes per timeout) and acceptable (85% [40/48] of hospitalists believed timeouts improved prescribing). Pharmacists recommended an antibiotic change in 25% (73/288) of timeouts with 70% (51/73) of recommended changes accepted by hospitalists. Barriers to adherence included unanticipated and weekend discharges. Compared to control services, there were no differences in antibiotic use after discharge during the intervention. Conclusions: A pharmacist-facilitated antibiotic timeout at discharge was feasible and holds promise as a method to improve antibiotic use at discharge.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 81%

Reducing overuse of antibiotics at discharge home: A single-center mixed methods pilot study

Giesler¹,

Krein²,

Brancaccio³

et al. 2022

American Journal of Infection Control

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“…Barnett et al performed a single-center, retrospective cohort study to evaluate the appropriateness of discharge antimicrobial prescriptions. 18 The AST reviewed 929 patients discharged on oral antimicrobials and made interventions on 9.7% (90/929) of prescriptions. Antimicrobial prescriptions were reviewed twice weekly, and as a result, 58% (52/90) of interventions were not implemented in a timely manner.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] Discharge AS remains an important gap in the literature, and few studies are available to describe AS interventions in this area. [15][16][17][18] Given that several studies have demonstrated the need for improved antimicrobial prescribing at transitions of care, we sought to create a streamlined process to identify antimicrobial DRPs encountered at hospital discharge. Using existing resources, our AST was successful in identifying DRPs in more than 40% of oral discharge antimicrobial prescriptions reviewed during a 6-month period.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have described AS efforts at discharge and their impact on antimicrobial prescribing. [15][16][17][18][19] Most studies focus on antimicrobial appropriateness before and after AS intervention, although intervention strategies vary between studies. Yogo et al performed a quasi-experimental, retrospective cohort study that used an institutional guideline with recommendations for oral step-down therapy and treatment duration in conjunction with prospective audit with real-time feedback to prescribers.…”

Section: Discussionmentioning

confidence: 99%

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Hospital Discharge: An Opportune Time for Antimicrobial Stewardship

et al. 2021

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Background: Approximately 30% of antimicrobials prescribed in the outpatient setting are unnecessary and up to 50% are inappropriate. Despite this, antimicrobial stewardship (AS) efforts mostly focus on the inpatient setting, and limited data describe AS interventions at hospital discharge. Acknowledging the potential value of discharge AS, we used our existing resources to review discharge oral antimicrobial prescriptions. Objective: The primary objective of this retrospective, single-center study was to evaluate the impact of an AS program on discharge oral antimicrobial prescriptions. Methods Discharge oral antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy, reviewed by an infectious diseases (ID) pharmacist, and recorded into our data collection tool from September 1, 2020, to February 28, 2021, were evaluated retrospectively. The primary outcome was to identify the frequency a drug-related problem (DRP) was identified by an ID pharmacist. Secondary outcomes included DRP characterization, percentage of prescriptions with interventions, intervention acceptance rate, and reduction in antimicrobial days dispensed at discharge when interventions to limit treatment duration were accepted. Results: Of the 803 discharge oral antimicrobial prescriptions reviewed, at least 1 DRP was identified in 43.1% (346/803). The most frequently identified DRPs pertained to treatment duration, drug selection, and dose selection. At least 1 intervention was recommended in 42.8% (344/803) of prescriptions. In total, 438 interventions were made and the acceptance rate was 75.6% (331/438). The most common types of interventions included recommendations for a different duration, a different dose or frequency, and antimicrobial discontinuation. When interventions to reduce treatment duration were accepted, the median (interquartile range) number of antimicrobial days decreased from 8 (5-10) days to 4 (0-5.5) days ( P < 0.001). Conclusion and Relevance: An ID pharmacist’s review of discharge oral antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy resulted in identification of DRPs and subsequent interventions in a substantial number of prescriptions.

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How Far We’ve Come, How Far We Have to Go: a Review of Advances in Antimicrobial Stewardship in the Veterans Health Administration

Ramakrishnan

Patel

2020

Curr Treat Options Infect Dis

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Antibiotic assessment at hospital discharge—Room for stewardship intervention

Cited by 7 publications

References 10 publications

Reducing overuse of antibiotics at discharge home: A single-center mixed methods pilot study

Reducing overuse of antibiotics at discharge home: A single-center mixed methods pilot study

Hospital Discharge: An Opportune Time for Antimicrobial Stewardship

How Far We’ve Come, How Far We Have to Go: a Review of Advances in Antimicrobial Stewardship in the Veterans Health Administration

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