Clinical outcome of pharmacist-led prospective audit with intervention and feedback after expansion from patients using specific antibiotics to those using whole injectable antibiotics

Ohashi, Kengo; Matsuoka, T.; Shinoda, Yasutaka; Mōri, Takayuki; Yoshida, Shinya; Yoshimura, Tomoaki; Sugiyama, Tadashi

doi:10.1007/s10096-018-03465-z

Cited by 12 publications

(9 citation statements)

References 28 publications

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“…15 A recent single-center study in Japan reported the results of modifying pharmacist-led PAF from select targeted IV antibiotic agents to all IV antibiotics. 16 The authors indicated there was a significant reduction in duration of IV antibiotics and a shorter length of patient stay, highlighting the potential benefits to a more comprehensive antibiotic assessment. Our approach of focusing on all patients on antibiotics resulted in a reduction of targeted agents with no compensatory increase in nontargeted antibiotics.…”

Section: Discussionmentioning

confidence: 99%

High versus low intensity: What is the optimal approach to prospective audit and feedback in an antimicrobial stewardship program?

Langford

Brown

Chan

et al. 2019

Infect. Control Hosp. Epidemiol.

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Background:Antimicrobial stewardship program (ASP) interventions, such as prospective audit and feedback (PAF), have been shown to reduce antimicrobial use and improve patient outcomes. However, the optimal approach to PAF is unknown.Objective:We examined the impact of a high–intensity interdisciplinary rounds–based PAF compared to low–intensity PAF on antimicrobial use on internal medicine wards in a 400–bed community hospital.Methods:Prior to the intervention, ASP pharmacists performed low–intensity PAF with a focus on targeted antibiotics. Recommendations were made directly to the internist for each patient. High–intensity, rounds–based PAF was then introduced sequentially to 5 internal medicine wards. This PAF format included twice–weekly interdisciplinary rounds, with a review of all internal medicine patients receiving any antimicrobial agent. Antibiotic use and clinical outcomes were measured before and after the transition to high–intensity PAF. An interrupted time–series analysis was performed adjusting for seasonal and secular trends.Results:With the transition from low–intensity to high–intensity PAF, a reduction in overall usage was seen from 483 defined daily doses (DDD)/1,000 patient days (PD) during the low–intensity phase to 442 DDD/1,000 PD in the high–intensity phase (difference, −42; 95% confidence interval [CI], −74 to −9). The reduction in usage was more pronounced in the adjusted analysis, in the latter half of the high intensity period, and for targeted agents. There were no differences seen in clinical outcomes in the adjusted analysis.Conclusions:High–intensity PAF was associated with a reduction in antibiotic use compared to a low–intensity approach without any adverse impact on patient outcomes. A decision to implement high–intensity PAF approach should be weighed against the increased workload required.

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Section: Discussionmentioning

confidence: 99%

High versus low intensity: What is the optimal approach to prospective audit and feedback in an antimicrobial stewardship program?

Langford

Brown

Chan

et al. 2019

Infect. Control Hosp. Epidemiol.

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“…8) However, few reports have investigated the FTEs of pharmacists and outcome measures. 6) In our institute, the FTE of ID pharmacists rose from 0.34 to 0.63 (median), and the DOTs of broad-spectrum antibiotics In our PPRF, increasing the FTE of ID pharmacists increased the suggestions for change of antibiotic (from 1.6 to 8.9%) and stopping antibiotics (from 1.1 to 5.1%), but suggestions regarding dosage optimization did not change (from 4.4 to 3.7%). These results imply that there was enough time to consider for dose optimization in the "before" period.…”

Section: Discussionmentioning

confidence: 99%

“…However, post-prescription review with feedback (PPRF) is an effective AS method that is comparable with preauthorization. 3,4) In Japan, ID pharmacists mainly use PAF or PPRF for broad-spectrum antibiotics, [4][5][6][7] but are unable to take enough full-time equivalents (FTEs) for AS. For enhancement of AS, the Japanese Society of Chemotherapy recommends FTEs of ID physicians and pharmacists by bed size.…”

Section: Introductionmentioning

confidence: 99%

Influence of Change of Full-Time Equivalents on Post-prescription Review with Feedback Interventions in an Antimicrobial Stewardship

Umemura

Mutoh

Ota

et al. 2022

Biological & Pharmaceutical Bulletin

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Few studies have investigated the influence of more full-time equivalents (FTEs) of infectious disease (ID) pharmacists on the likelihood of a post-prescription review with feedback (PPRF) intervention. This study focused on this in community hospitals before and after the Japanese medical reimbursement system was revised to introduce antimicrobial stewardship (AS) fees. We collected data for two periods: before (April 2017 to March 2018) and after (April 2018 to March 2019) AS fee implementation. The efficacy of the PPRF by the ID pharmacist was assessed based on the usage of broad-spectrum antimicrobials in days of therapy (DOT) per 100 patient-days. Further, we generated the susceptibility rate for antimicrobial-resistant organisms. The number of PPRF drugs was 2336 (2596 cases) before AS fee implementation and 2136 (1912 cases) after implementation. The overall monthly FTE for AS for an ID pharmacist increased from [median (interquartile range; IQR)] 0.34 (0.33-0.36) to 0.63 (0.61-0.63) after AS fee implementation. The DOT of the broad-spectrum antibiotics decreased from 10.46 (9.61-12.48) to 8.68 (8.14-9.18). The DOT of carbapenems and quinolones decreased significantly from 4.11 (3.69-4.41) to 3.07 (2.79-3.22) and 0.96 (0.61-1.14) to 0.37 (0.19-0.46), respectively (p < 0.05). Furthermore, the rate of levofloxacin (LVFX)-susceptible Pseudomonas (P.) aeruginosa improved from 71.5 to 84.8% (p < 0.01). We observed that increasing the FTE of ID pharmacists influences the DOTs of broad-spectrum antibiotics; a higher FTE contributes to fewer DOTs. Further, the susceptibility of P. aeruginosa to meropenem and LVFX increased as the FTE increased.

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“…Although several reports indicated that frequent monitoring of antimicrobial therapies lead to early intervention and resulted in improved patient outcomes, 5 no report has yet shown the impact of an increase in monitoring frequency per day as a PAF strategy. In the present study, we evaluated the clinical impact of an increase in the monitoring frequency per day as a PAF strategy in patients receiving antimicrobial agents by injection.…”

Section: Discussionmentioning

confidence: 99%

“…Campbell et al indicated that the impact of PAF is likely dependent on how frequently it is conducted, how quickly after antibiotic prescription it is initiated, and which antibiotics are targeted 4 . Indeed, several reports indicate that more frequent monitoring of antimicrobial therapies leads to early intervention and results in improved patient outcomes 5‐7 …”

Section: Introductionmentioning

confidence: 99%

Clinical impact of monitoring frequency per day as a prospective audit and feedback strategy for patients receiving antimicrobial agents by injection

et al. 2021

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Implementation of antimicrobial stewardship programmes (ASPs) improves antimicrobial therapies and results in better patient outcomes and safety. A recent systemic review and meta-analysis demonstrated that ASPs lead to reductions in total antibiotic use within hospitals as well as antibiotic acquisition costs. Although the strategies utilised varied, most successful ASPs incorporated a prospective audit and feedback (PAF) strategy as a critical component. 1

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Clinical outcome of pharmacist-led prospective audit with intervention and feedback after expansion from patients using specific antibiotics to those using whole injectable antibiotics

Cited by 12 publications

References 28 publications

High versus low intensity: What is the optimal approach to prospective audit and feedback in an antimicrobial stewardship program?

High versus low intensity: What is the optimal approach to prospective audit and feedback in an antimicrobial stewardship program?

Influence of Change of Full-Time Equivalents on Post-prescription Review with Feedback Interventions in an Antimicrobial Stewardship

Clinical impact of monitoring frequency per day as a prospective audit and feedback strategy for patients receiving antimicrobial agents by injection

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