Antibiotic de-escalation on internal medicine services with rounding pharmacists compared to services without

Ford, Bethany A.; Martello, Jay L.; Wietholter, Jon P.; Piechowski, Kara

doi:10.1007/s11096-020-01029-w

Cited by 7 publications

(9 citation statements)

References 19 publications

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“…A recent prospective study at an academic hospital in the USA revealed that de-escalation is most likely to occur if pharmacists participated in multidisciplinary ward rounds. De-escalations were recommended for 35/39 patients when clinical internal medicine pharmacists joined ward rounds, compared to 13/25 patients on services without pharmacists ( P = 0.001) [ 43 ]. In SA, evidence suggests that multidisciplinary ward rounds are an integral component of stewardship.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship in Public-Sector Hospitals in KwaZulu-Natal, South Africa

Chetty

Reddy²,

Ramsamy

et al. 2022

Antibiotics

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Antimicrobial resistance (AMR) is a serious global public-health threat. Evidence suggests that antimicrobial stewardship (AMS) is a valuable tool to facilitate rational antibiotic use within healthcare facilities. A cross-sectional situational analysis using a questionnaire was conducted to determine the current status of antimicrobial stewardship (AMS) activities in all public-sector hospitals in KwaZulu-Natal (KZN). The survey had a 79% (57, N = 72) response rate. A total of 75% of hospitals had an antimicrobial stewardship committee (AMSC), 47% (20, N = 43) had a formal written statement of support from leadership, and 7% (3, N = 43) had budgeted financial support. Only 37% (16, N = 43) had on-site or off-site support from a clinical microbiologist, and 5% (2, N = 43) had an on-site infectious disease (ID) physician. Microbiologist input on pathogen surveillance data (aOR: 5.12; 95% CI: 4.08–22.02; p-value = 0.001) and microbiological investigations prior to the commencement of antibiotics (aOR: 5.12; 95% CI: 1.08–42.01; p-value = 0.041) were significantly associated with having either on- or off-site microbiology support. Respondents that had a representative from microbiology on the AMSC were significantly associated with having and interrogating facility-specific antibiograms (P = 0.051 and P = 0.036, respectively). Those facilities that had access to a microbiologist were significantly associated with producing an antibiogram (aOR: 4.80; 95% CI: 1.25–18.42; p-value = 0.022). Facilities with an ID physician were significantly associated with having a current antibiogram distributed to prescribers within the facility (P = 0.010) and significantly associated with sending prescribers personalized communication regarding improving prescribing (P = 0.044). Common challenges reported by the facilities included suboptimal hospital management support; a lack of clinicians, pharmacists, nurses, microbiologists, and dedicated time; the lack of a multidisciplinary approach; low clinician buy-in; inadequate training; a lack of printed antibiotic guidelines; and financial restrictions for microbiological investigations. The survey identified the need for financial, IT, and management support. Microbiology and infectious disease physicians were recognized as scarce human resources.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship in Public-Sector Hospitals in KwaZulu-Natal, South Africa

Chetty

Reddy²,

Ramsamy

et al. 2022

Antibiotics

View full text Add to dashboard Cite

show abstract

“…However, reports regarding efforts to reduce antibiotic usage have mainly focused on interventions for in-hospital prescriptions and injectables. [5][6][7][8][9][15][16][17][18][19]24,25 In addition, no reports are examining the effects of interventions on outpatient prescriptions. This is the first report to evaluate the effects of a revised antibiotic formulary on both in-and out-hospital prescriptions to the best of our knowledge.…”

Section: Discussionmentioning

confidence: 99%

“…Fujibayashi et al reported that revising clinical pathways effectively reduced antibiotic consumption and shortened the antibiotic administration period without increasing the incidence of surgical site infections. 10 Preauthorization and prospective audit and feedback [5][6][7][8][9]24,25 the usage of oral cephalosporins, macrolides and fluoroquinolones to the 50% target. In the future, it is thought that these combined efforts will be necessary at our hospital as well.…”

Section: Discussionmentioning

confidence: 99%

Revised hospital antibiotic formulary reduces antimicrobial consumption and promotes a shift towards narrow‐spectrum antibiotic usage

et al. 2021

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Antimicrobial resistance (AMR) of microorganisms to antibiotics has been declared a serious threat to global public health and an issue that requires intervention across all social and government sectors.The emergence and spread of AMR threaten our ability to treat common infectious diseases, resulting in prolonged illness, disability, increasing healthcare costs and higher mortality rates. 1 In April 2016, the Government of Japan devised a national action plan to intensify efforts and measures against AMR. 2 The plan presented priorities to be implemented over the next 5 years to promote measures against AMR in the country. Approximately 90% of antimicrobials consumed in Japan are oral medications, which are prescribed to patients over an extensive age range, whereas injectable antibiotics

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“…Other studies have focused on pharmacist interventions for broad spectrum agents, but our study reports IM pharmacists' impact on a wider list of antimicrobials in an attempt to improve expansion of AMS efforts. 19,20 Within our prespecified categories, most documented interven-…”

Section: Ofmentioning

confidence: 99%

“…Pharmacist generalists, such as internal medicine (IM) clinical pharmacists, are poised in a role to help expand AMS efforts. Studies show that IM clinical pharmacists functioning within multidisciplinary teams in acute care hospitals significantly improve patient care by reducing medication errors, ensuring appropriate transitions of care, and educating other health care providers 14–19 . Additionally, IM pharmacists use prospective audit and feedback and post‐prescription review to optimize antimicrobial agent selection, adjust antimicrobial doses, and monitor efficacy and safety of antimicrobials.…”

Section: Introductionmentioning

confidence: 99%

Impact of internal medicine pharmacists on antimicrobial stewardship

Rizzo,

Suchindran,

Albrecht

et al. 2024

J Am Coll Clin Pharm

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IntroductionIncreased demands on infectious diseases (ID) pharmacists and providers may result in targeted antimicrobial stewardship (AMS) interventions. Internal medicine (IM) pharmacists frequently intervene on antimicrobials for their patients during general clinical care, although little is known regarding their overall impact on AMS.ObjectiveCharacterize AMS interventions made by IM pharmacists to identify areas of AMS that can be expanded to patients not covered by ID teams.MethodsThis was a prospective, dual‐center, cross‐sectional study where IM pharmacists, and their trainees were recruited to document routinely made AMS interventions that happened during daily patient care activities. These interventions were classified based on infection source, stewardship intervention type, whether recommendations were accepted or rejected by providers, and any barriers incurred during the implementation of interventions.ResultsFour IM pharmacists documented 386 interventions from February 2021 through May 2021. Physicians accepted pharmacist interventions 95.6% of the time. The most common interventions were for respiratory (n = 87, 22.5%), genitourinary (n = 80, 20.7%), and skin and skin structure infections (n = 65, 16.8%). The antimicrobials that IM pharmacists most frequently intervened on were vancomycin (n = 89, 23.1%) and ceftriaxone (n = 68, 17.6%). The most common interventions that were made were dose adjustment (n = 105, 27.2%), shortened duration of therapy (n = 86, 22.3%), and intravenous (IV) to oral (PO) conversions (n = 38, 9.8%). Of the 17 interventions not accepted, the most common barrier to implementation was physician concerns (n = 11, 52.4%), which were primarily associated with IV to PO recommendations (n = 7, 63.6%).ConclusionIM pharmacists participate in AMS for their patients and intervene frequently to adjust dosing for antimicrobials, shorten duration of therapy, and facilitate IV to PO conversions. IM pharmacists could serve as AMS extenders where additional AMS coverage is needed.

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Antibiotic de-escalation on internal medicine services with rounding pharmacists compared to services without

Cited by 7 publications

References 19 publications

Antimicrobial Stewardship in Public-Sector Hospitals in KwaZulu-Natal, South Africa

Antimicrobial Stewardship in Public-Sector Hospitals in KwaZulu-Natal, South Africa

Revised hospital antibiotic formulary reduces antimicrobial consumption and promotes a shift towards narrow‐spectrum antibiotic usage

Impact of internal medicine pharmacists on antimicrobial stewardship

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