Evaluation of a pharmacist-led antibiotic stewardship program and implementation of prescribing order sets

Blow, Curtis; Harris, Jenna; Murphy, Meaghan; Conn, Kelly M.; Toomey, Caitlin; Huml, Isaac; Phillips, Elizabeth

doi:10.1016/j.japh.2021.01.030

Cited by 2 publications

(6 citation statements)

References 13 publications

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“…12 They found no difference in the proportion of total guideline-recommended antibiotic regimens prescribed after implementation of the order sets (P = .703). 12 The authors noted that in subgroup analyses of both disease states, agent selection did improve. This study was limited by a small sample size; additionally, the authors did not report compliance with the use of the order sets.…”

Section: Discussionmentioning

confidence: 95%

“…The authors noted that in subgroup analyses of both disease states, agent selection did improve. This study was limited by a small sample size; additionally, the authors did not report compliance with the use of the order sets 12 . Giancola et al also evaluated the impact of order sentences on prescribing for uncomplicated UTI in 1649 patients; however, they only measured the impact on durations prescribed.…”

Section: Discussionmentioning

confidence: 99%

“…Blow et al recently conducted a single‐center, retrospective study to assess the impact of outpatient order sets on the proportion of compliance with guideline‐recommended antibiotic use for 158 patients with UTI or Helicobacter pylori infection 12 . They found no difference in the proportion of total guideline‐recommended antibiotic regimens prescribed after implementation of the order sets ( P = .703) 12 . The authors noted that in subgroup analyses of both disease states, agent selection did improve.…”

Section: Discussionmentioning

confidence: 99%

“…This study was limited by a small sample size; additionally, the authors did not report compliance with the use of the order sets. 12 Giancola et al also evaluated the impact of order sentences on prescribing for uncomplicated UTI in 1649 patients; however, they only measured the impact on durations prescribed. The authors found that adherence to recommended duration of therapy increased from 29.4% to 76.3% (P < .01), with a decrease in average days prescribed from 6.6 to 5.1 (P < .01).…”

Section: Discussionmentioning

confidence: 99%

“…Due to this limitation, methods other than manual audit‐and‐feedback must be explored to optimize antibiotic prescribing with limited resources. Optimizing prescribing through order sentence creation within the ambulatory electronic health record (EHR) may allow ASPs to extend their reach with limited resources; however, limited data are available evaluating this method of stewardship and their results are conflicting 10‐13 . The purpose of this study was to determine whether implementation of stewardship‐driven order sentences within the outpatient EHR and education improves guideline‐concordant antibiotic prescribing for urinary tract infections (UTI) and skin and soft tissue infections (SSTI).…”

Section: Introductionmentioning

confidence: 99%

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Impact of order sentence implementation on outpatient antibiotic prescribing for urinary tract infection and skin and soft tissue infection

Foreman

Westerhof

Benzer

et al. 2021

J Am Coll Clin Pharm

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Introduction Due to the high volume of outpatient antibiotic prescribing, the Joint Commission now requires antimicrobial stewardship program (ASP) expansion to ambulatory practice settings. Unfortunately, ASP resources in these settings are scarce. The purpose of this study was to determine whether the implementation of antibiotic order sentences alongside education would improve antibiotic prescribing for urinary tract infections (UTI) and skin and soft tissue infections (SSTI). Objectives The primary objective was to compare the proportion of total guideline‐concordant antibiotic prescribing before (pre‐ASP) vs after (post‐ASP) implementing order sentences. Guideline concordance was defined as antibiotic selection, dosing, and duration in accordance with the health system's empiric guidelines. Secondary objectives included comparing patient‐centered outcomes, such as infection‐related revisits and Clostridiodes difficile infections between groups. Methods This retrospective, quasi‐experimental study evaluated adult patients treated for uncomplicated UTI or SSTI at an outpatient Family Medicine office between 1 February 2020 and 1 January 2021. The institution's stewardship team provided in‐person education and set prescribing order sentence “favorites” for providers. Patients were excluded who were diagnosed with a complicated UTI, treated only with topical antibiotics, were pregnant, or received care via telephone encounter. Results Two hundred sixty patients were included in this study (pre‐ASP n = 139, post‐ASP n = 121). Total antibiotic appropriateness improved significantly from 24.5% to 39.7% after implementation of order sentences and education (P = .008). Significant improvement was seen for appropriate drug selection (52.5% vs 66.9%, P = .018) and duration (47.5% vs 68.6%, P = .001). There were no differences observed in patient‐centered outcomes between groups. Conclusion Implementing stewardship‐focused order sentences significantly improved outpatient antibiotic prescribing for UTI and SSTI. Tailoring antibiotic order sentences may be a useful tool for ASP expansion into the outpatient setting with limited resources to allocate to stewardship efforts.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of order sentence implementation on outpatient antibiotic prescribing for urinary tract infection and skin and soft tissue infection

Foreman

Westerhof

Benzer

et al. 2021

J Am Coll Clin Pharm

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A five-year quasi-experimental study to evaluate the impact of empiric antibiotic order sets on antibiotic use metrics among hospitalized adult patients

Kufel,

Steele,

Mahapatra

et al. 2024

Infect. Control Hosp. Epidemiol.

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Objective: Evaluation of adult antibiotic order sets (AOSs) on antibiotic stewardship metrics has been limited. The primary outcome was to evaluate the standardized antimicrobial administration ratio (SAAR). Secondary outcomes included antibiotic days of therapy (DOT) per 1,000 patient days (PD); selected antibiotic use; AOS utilization; Clostridioides difficile infection (CDI) cases; and clinicians’ perceptions of the AOS via a survey following the final study phase. Design: This 5-year, single-center, quasi-experimental study comprised 5 phases from 2017 to 2022 over 10-month periods between August 1 and May 31. Setting: The study was conducted in a 752-bed tertiary care, academic medical center. Intervention: Our institution implemented AOSs in the electronic medical record (EMR) for common infections among hospitalized adults. Results: For the primary outcome, a statistically significant decreases in SAAR were detected from phase 1 to phase 5 (1.0 vs 0.90; P < .001). A statistically significant decreases were detected in DOT per 1,000 PD (4,884 vs 3,939; P = .001), fluoroquinolone orders (407 vs 175; P < .001), carbapenem orders (147 vs 106; P = .024), and clindamycin orders (113 vs 73; P = .01). No statistically significant change in mean vancomycin orders was detected (991 vs 902; P = .221). A statistically significant decrease in CDI cases was also detected (7.8, vs 2.4; P = .002) but may have been attributable to changes in CDI case diagnosis. Clinicians indicated that the AOSs were easy to use overall and that they helped them select the appropriate antibiotics. Conclusions: Implementing AOS into the EMR was associated with a statistically significant reduction in SAAR, antibiotic DOT per 1,000 PD, selected antibiotic orders, and CDI cases.

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Evaluation of a pharmacist-led antibiotic stewardship program and implementation of prescribing order sets

Cited by 2 publications

References 13 publications

Impact of order sentence implementation on outpatient antibiotic prescribing for urinary tract infection and skin and soft tissue infection

Impact of order sentence implementation on outpatient antibiotic prescribing for urinary tract infection and skin and soft tissue infection

A five-year quasi-experimental study to evaluate the impact of empiric antibiotic order sets on antibiotic use metrics among hospitalized adult patients

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