Evaluating the Need for Antibiotic Stewardship Prospective Audit and Feedback on Weekends

Freeman, Tracelyn; Eschenauer, Gregory A.; Patel, Twisha S; Gandhi, Tejal; Petty, Lindsay A; Chenoweth, Carol E.; Santarossa, Maressa; Nagel, Jerod

doi:10.1017/ice.2017.174

Cited by 2 publications

(1 citation statement)

References 2 publications

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“…3 Freeman and colleagues identified the potential for a reduction in 2257 unnecessary days of therapy (DOT) over 1 year if antimicrobial timeouts were expanded to the weekend. 4 While these studies suggest potential benefit of weekend ASP services, further data are needed to measure the actual impact.…”

Section: Introductionmentioning

confidence: 99%

The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

Bohn

Neuner

Athans

et al. 2021

Journal of Pharmacy Practice

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Background: In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services. Methods: This single-center, quasi-experimental study included data from weekends before (9/2017–11/2017) and after (9/2018–11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes. Results: During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes. Conclusion: Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services.

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Section: Introductionmentioning

confidence: 99%

The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

Bohn

Neuner

Athans

et al. 2021

Journal of Pharmacy Practice

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Cluster randomized trial of an antibiotic time-out led by a team-based pharmacist

Schooneveld

Rupp

Cavaleiri

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: Antibiotic time-outs (ATOs) have been advocated to improve antibiotic use without dedicated stewardship resources, but their utility is poorly defined. We sought to evaluate the effectiveness of an ATO led by a team-based pharmacist. Design: Cluster randomized controlled trial. Setting: Six medicine teams at an academic medical facility. Patients: Inpatients who received antibiotics and were cared for by a medicine team. Intervention: In phase A (2 months) pharmacist-led ATOs were implemented on 3 medicine teams (ATO-A) while 3 teams maintained usual care (UC-A). In phase B (2 months), ATOs were continued in the ATO group (ATO-B) and ATOs were initiated in the UC group (UC ATO-B). We targeted 2 ATO points: early (<72 hours after antibiotics were initiated) and late (after the early period but ≤5 days after antibiotic initiation). Results: In total, 290 ATOs were documented (181 early, 87 late, and 22 subsequent) among 538 admissions. The most common ATO recommendations were narrow therapy (148 of 290), no change (124 of 290), and change to oral (30 of 290). ATO initiation was lower in the UC ATO-B group than in either ATO group (21.8% UC ATO-B vs 69.2% ATO-A and -B). Overall antibiotic use was not different between the groups (P = .51), although intravenous (IV) levofloxacin use decreased in the UC group after ATO implementation (49 DOT/1,000 PD vs 20 DOT/1,000 PD; P = .022). The ratio of oral (PO) to intravenous (IV) DOT was lower in the UC group than in any of the ATO groups (P = .032). We detected no differences in mortality, length of stay, readmission, C. difficile infection, or antibiotic adverse events. Conclusions: Implementation of a pharmacist-led ATO was feasible and well accepted but did not change overall antibiotic use. An ATO may promote increased use of oral antibiotics, but more effective strategies for self-stewardship are needed.

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Evaluating the Need for Antibiotic Stewardship Prospective Audit and Feedback on Weekends

Cited by 2 publications

References 2 publications

The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

Cluster randomized trial of an antibiotic time-out led by a team-based pharmacist

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