Assessing an intervention to improve the safety of automatic stop orders for inpatient antimicrobials

Abstract

Summary Background Automatic stop orders (ASOs) for antimicrobials have been recommended as a component of antimicrobial stewardship programs, but may result in unintentional treatment interruption due to failure of providers to re-order an antimicrobial medication. We examined the impact of a multifaceted intervention designed to reduce the potential harms of interrupting antimicrobial treatment due to ASOs. Methods An intervention was implemented that included pharmacist review of expiring antimicrobials as well as provider education to encourage use of a long-term antimicrobial order set for commonly used prophylactic antimicrobials. Pharmacist interventions and antimicrobial re-ordering was recorded. Percent of missed doses of a commonly used prophylactic antimicrobial, single strength co-trimoxazole, was compared pre- and post-intervention using a chi-squared test. Results From November 1, 2015 to November 30, 2016, there were 401 individual pharmacist interventions for antimicrobial ASOs, resulting in 295 instances of antimicrobial re-ordering. The total percent of presumed missed single strength co-trimoxazole doses was reduced from 8.4% to 6.2% post-intervention ( P <0.001). Conclusions This study found that a targeted intervention was associated with a reduction in unintended antimicrobial treatment interruption related to ASOs.

An overview of the hospitals’ antimicrobial stewardship programs implemented to improve antibiotics’ utilization, cost and resistance patterns

“…The persuasive AMS interventions are comprised of education of the prescribers, development of the AMS guidelines along with the modification of the clinical pathways (Neo et al, 2020). The formulary restriction (pre-authorization) of the prescriptions mainly from an infectious disease (ID) physician, microbiologist or clinical pharmacist, stop order (de-escalation) practice for some highly consumed antibiotics along with the practice of antibiotic cycling or switch over between various antibiotic groups are some of the restrictive interventions being implemented as part of the hospitals' AMS programs (Dutcher et al, 2020). The structural interventions for the AMS are mainly the prospective (post-prescription) audit and the introduction of the computerized decision support system (CDSS) that automatically guides the prescribers regarding the AMS guidelines for a particular antibiotic (Huh et al, 2016).…”

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit

“…We acknowledge that automatic stop times may lead to unintentional interruptions in antibiotic therapy and require close monitoring by team members. 28 Diagnostic stewardship is fundamental to antimicrobial stewardship within pediatric intensive care units. 29 Judicious blood culture practices have decreased broad-spectrum antibiotic use in critically ill children.…”

“…We acknowledge that automatic stop times may lead to unintentional interruptions in antibiotic therapy and require close monitoring by team members. 28 …”

Avaliação dos elementos essenciais de um programa de gerenciamento de antimicrobianos: perspectiva dos profissionais de saúde em um hospital de Ensino

“…Time-sensitive automatic stop requests for specific antimicrobial prescriptions have not yet been fully implemented at the institution 14 . Time-sensitive alert systems and discontinuation requests may improve therapy outcomes with these medications [18][19][20] . It has already been shown, for example, that a positive blood culture alert system associated with the intervention of a pharmacist managing antimicrobials resulted in a reduction in therapy time, hospitalization time and mortality related to Gram-negative bacteremia 19 .…”

“…It has already been shown, for example, that a positive blood culture alert system associated with the intervention of a pharmacist managing antimicrobials resulted in a reduction in therapy time, hospitalization time and mortality related to Gram-negative bacteremia 19 . In turn, antimicrobial discontinuation requests can prevent unnecessary use, although acceptance of this practice by professionals has been lower due to the therapy inappropriate discontinuation risk 18,20 .…”