Antimicrobial Stewardship Programs: How to Start and Steer a Successful Program

Drew, Richard H.

doi:10.18553/jmcp.2009.15.s2.18

Cited by 110 publications

(115 citation statements)

References 40 publications

(43 reference statements)

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“…Antibiyotik yönetim programının geliştirilme-si ve devamlılığının sağlanması için program finansmanı, kurumsal politika ve doktor özerkliği gibi konuların hastane yönetimi tarafından dikkate alınarak, gerekli desteğin verilmesi gerekmektedir [14,[17][18][19] .…”

Section: Anti̇bi̇yoti̇k Yöneti̇mi̇ Eki̇bi̇unclassified

“…Bir antibiyotik komitesi tarafından, ajanların onaylanan kullanımına ilişkin kılavuzlar oluşturulur. Bu strateji, istek yapıldığında hekimler için eğitim fırsatına ve antibiyotik kullanımı üzerinde doğru-dan kontrole olanak sağlamaktadır [19] .…”

Section: çEkirdek Stratejiler a Formüler Kısıtlama Ve öN Onayunclassified

“…Müdahale ve geribildirim ile prospektif denetim: Bu strateji, hedeflenen ajanların uygunluğunun günlük olarak incelenmesini, gerekirse alternatif ajan önermesi için reçeteyi yazan doktorla temasa geçmeyi de içermektedir. Bu stratejinin uygulanmasında, hedefe yönelik ajanların uygun kullanımı için antibiyotik komitesine, değerlendirmeleri yapmak ve günlük olarak iletişi-mi takip etmek için de genellikle klinik eczacılara ihtiyaç duyulmaktadır [19] . Bu strateji, ön onay stratejisinden daha esnek olma ve hastaya özgü bakımı kolaylaştırma eğilimindedir.…”

Section: çEkirdek Stratejiler a Formüler Kısıtlama Ve öN Onayunclassified

“…Antibiyotik yönetim ekibinin önerileri, reçeteyi yazan doktorlara iletilmiştir. Programın uygulanmasını takiben parenteral antibiyotik maliyeti yaklaşık %30 azalırken, parenteral antibiyotik kullanımı da giderek azalmıştır [19] .…”

Section: çEkirdek Stratejiler a Formüler Kısıtlama Ve öN Onayunclassified

“…Kombinasyon tedavisi: Kombinasyon tedavisinin, sonuçların iyileştirilmesi veya direnç gelişiminin önlenmesi üzerindeki etkisini destekleyen veri eksikliği nedeniyle rutin olarak kullanı-mı önerilmemektedir [14,19] . Yapılan bir çalışmada, kombine antibiyotik tedavisinin gram-negatif bakteremisi olan hastalarda mortaliteyi azaltmadığı belirtilmiştir.…”

Section: Tedavinin Sadeleştirilmesi Ya Da De-eskalasyonuunclassified

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Antibiyotik Yönetimi Ekibi ve Eczacının Rolü

Çavdar¹,

Demirkan²,

Bayraktar-Ekincioglu³

et al. 2016

FLORA

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Section: Anti̇bi̇yoti̇k Yöneti̇mi̇ Eki̇bi̇unclassified

Section: çEkirdek Stratejiler a Formüler Kısıtlama Ve öN Onayunclassified

Section: Tedavinin Sadeleştirilmesi Ya Da De-eskalasyonuunclassified

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Antibiyotik Yönetimi Ekibi ve Eczacının Rolü

Çavdar¹,

Demirkan²,

Bayraktar-Ekincioglu³

et al. 2016

FLORA

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Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals

et al. 2017

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IMPORTANCE Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs.OBJECTIVE To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. DESIGN, SETTING, AND PARTICIPANTSThe Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. INTERVENTIONSWe offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing.MAIN OUTCOMES AND MEASURES Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time.RESULTS A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period. The mean antimicrobial appropriateness increased from 64.1% at intervention start to 77.4% at 12-month follow-up (+13.3%; relative risk, 1.17; 95% CI, 1.04-1.27), without a change in slope. No decrease in antimicrobial consumption was found.CONCLUSIONS AND RELEVANCE Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various health care environments.

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Snapshot of Barriers to and Indicators for Antimicrobial Stewardship in Australian Hospitals

Chen

Khumra

Eaton

et al. 2011

Pharmacy Practice and Res

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Background: Effective antimicrobial stewardship programs are vital in an environment of emerging resistance to existing antimicrobials and the limited availability of new antimicrobials. There are institutional barriers to successful implementation of these programs. Key performance indicators (KPI) are useful for determining the success of antimicrobial stewardship programs and for benchmarking purposes. Aim: To identify barriers to implementation of antimicrobial stewardship programs, KPI used to measure program outcomes and the perceived usefulness of these KPI in Australian hospitals. Method: Australian Directors of Pharmacy in private and public hospitals or their nominees (n = 281) were surveyed by mail to identify barriers to, and KPI used for antimicrobial stewardship programs at their hospitals. Hospital pharmacists, infectious diseases clinicians and infection control nurses were interviewed until saturation of themes was reached. Results: Response rate for the postal survey was 29% (n = 80). Main barriers to implementing antimicrobial stewardship programs encountered by respondents included: lack of education and training related to antimicrobial usage; prescribing culture at the hospital which was resistant to change; lack of resources to conduct stewardship activities; and lack of feedback to doctors, nurses and pharmacists on institutional antimicrobial use. Only 14 respondents used KPI to measure program outcomes. The KPI used between institutions were variable. Conclusion: Australian hospitals encounter many barriers to implementing antimicrobial stewardship programs. There were no standard national KPI to measure program outcomes. Most participants agreed that the KPI at their hospitals were useful. J Pharm Pract Res 2010; 40: x-x.

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Antimicrobial Stewardship Programs: How to Start and Steer a Successful Program

Cited by 110 publications

References 40 publications

Antibiyotik Yönetimi Ekibi ve Eczacının Rolü

Antibiyotik Yönetimi Ekibi ve Eczacının Rolü

Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals

Snapshot of Barriers to and Indicators for Antimicrobial Stewardship in Australian Hospitals

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