Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

Huang, Joanne; Escobar, Zahra Kassamali; Bouchard, Todd; Lansang, Jose Mari; Jain, Rupali; Chan, Jeannie D.; Lynch, John B.; D’Angeli, Marisa A; May, Larissa; Bryson-Cahn, Chloe

doi:10.1017/ice.2020.1394

Cited by 5 publications

(4 citation statements)

References 8 publications

(1 reference statement)

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“…Whilst the initial lift of implementing this antimicrobial stewardship intervention, including building and verifying the inappropriate antibiotic prescribing report was significant, 8 we have found maintenance sustainable. The antibiotic commitment posters remain signed and posted in clinic exam rooms.…”

Section: Discussionmentioning

confidence: 88%

“…These changes were made based on feedback from the providers. 8 For sustainability of our intervention, in September of 2020, we decreased the volume of individualized feedback from 12 urgent and primary care clinics and the ED (145 providers) to 4 clinics (21 providers) and the director of the ED. The selected clinics included two urgent care centres with the highest inappropriate antibiotic prescribing rates, and their two geographically corresponding primary care clinics.…”

Section: Methodsmentioning

confidence: 99%

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A single-centre experience rolling out an antibiotic stewardship intervention prior to and during the SARS-CoV-2 pandemic 2019–2022

Escobar¹,

Bouchard²,

Buck³

et al. 2023

DIC

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Background Antibiotics are prescribed to nearly one-half of patients with viral respiratory tract infections (RTI) in outpatient settings. This use is ineffective and may cause undue harm and excess cost from unnecessary antibiotic exposure. We implemented a multifaceted intervention to address inappropriate antibiotic prescribing for viral RTI. Here, we discuss the impact over 4 years, before and during the SARS-CoV-2 pandemic. Methods This observational study describes the implementation and initial impact of a multimodal stewardship intervention on inappropriate antibiotic prescribing for viral RTIs in outpatient care settings at a single centre. We tracked the rate of visits for viral RTI as well as antibiotic prescribing for viral RTIs in urgent care, primary care and the emergency department between January 2018 and March 2022. Data were collected 1 year prior to implementation and 3 years after implementation. The primary outcome – the rate of inappropriate antibiotics prescribed for viral RTIs – was described by calendar year (CY) to review changes after the stewardship intervention. Results In CY2018, the year prior to implementation of targeted RTI antimicrobial stewardship, the rate of inappropriate RTI antibiotics prescribed was 10% in urgent care, 11% in primary care and 18% in the emergency department (ED). During the first CY of the intervention, rates were 8% in urgent care, 10% in primary care and 16% in the ED. In CY2020, the second year of the intervention, inappropriate RTI antibiotics were prescribed in 5% of urgent care and 3% primary care RTI visits and 15% of ED RTI visits. These rates were similar in CY2021 and the first 3 months of CY2022. Over 30,000 visits for RTIs were seen annually in CY2018 and CY2019. Annual RTI visits dropped to 20,222 in CY2020 and 14,172 in CY2021. Conclusion Although total visits for non-COVID RTIs decreased by approximately 50% during the first 2 years of the SARS-CoV-2 pandemic, an antimicrobial stewardship intervention was associated with decreases in inappropriate antibiotic prescribing for RTIs. This was maintained throughout 2 years of the pandemic. This article is part of the Antibiotic stewardship Special Issue: https://www.drugsincontext.com/special_issues/antimicrobial-stewardship-a-focus-on-the-need-for-moderation

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Section: Discussionmentioning

confidence: 88%

Section: Methodsmentioning

confidence: 99%

A single-centre experience rolling out an antibiotic stewardship intervention prior to and during the SARS-CoV-2 pandemic 2019–2022

Escobar¹,

Bouchard²,

Buck³

et al. 2023

DIC

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“…We previously described the significant amount of support required to build these data sets 7 ; one was not easier to build than the other. Although the technical specifications revealed the same trends, the end-user experiences differed.…”

Section: Discussionmentioning

confidence: 99%

Experience with two antimicrobial prescribing tools in ambulatory care settings

Escobar

Thomasson

Bouchard

et al. 2022

ASHE

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“…For supplementary material accompanying this paper visit https://doi.org/10.1017/ice.2021.480 This report describes how the MITIGATGE tool kit was adapted to a network of urgent care centers, primary care clinics and emergency departments. 72 Adoption Intention or initial decision to try to use an evidence-based practice or implementation strategy Preimplementation A cross-sectional survey was conducted to assess how many hospitals reported the adoption of the CDC Core Elements for hospital-based stewardship programs. The reported uptake of all 7 core elements was 41% in 2014 and 48% in 2015.…”

Section: Putting It All Togethermentioning

confidence: 99%

Leveraging implementation science to advance antibiotic stewardship practice and research

Livorsi

Drainoni

Reisinger

et al. 2021

Infect. Control Hosp. Epidemiol.

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Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

Cited by 5 publications

References 8 publications

A single-centre experience rolling out an antibiotic stewardship intervention prior to and during the SARS-CoV-2 pandemic 2019–2022

A single-centre experience rolling out an antibiotic stewardship intervention prior to and during the SARS-CoV-2 pandemic 2019–2022

Experience with two antimicrobial prescribing tools in ambulatory care settings

Leveraging implementation science to advance antibiotic stewardship practice and research

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