Impact of an antimicrobial stewardship programme on patient safety in Singapore General Hospital

Liew, Yi Xin; Lee, Winnie; Loh, Joan Chain Zhu; Cai, Yiying; Tang, Sarah Si Lin; Lim, Chin Hong; Teo, Jin Yao; Ong, Rachel; Kwa, Andrea Lay-Hoon; Chlebicki, Maciej Piotr

doi:10.1016/j.ijantimicag.2012.03.004

Cited by 45 publications

(58 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It was also encouraging to observe that the appropriateness of carbapenem prescribing improved from 72% pre-ASP implementation to 78% at 2.5 years after ASP implementation, and to 81% in the year 2014. Our findings in terms of patient safety outcomes were similar to other local studies in adult populations by Teng et al (11) and Liew et al (16), where there were no significant differences in terms of mortality and 30-day readmission rates between patients on carbapenems with and without acceptance of ASP. Pitt bacteremia score was a predictor of 30-day mortality in one study (11), similar to our findings where illness severity was a risk factor for mortality.…”

Section: Discussionsupporting

confidence: 91%

Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes

Seah

Ong

Lim

et al. 2017

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobial use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when deescalation or discontinuation of broadspectrum antibiotics is recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers. We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014. Intervention acceptance and outcomes, including carbapenem utilization, length of stay, hospitalization charges, 30-day readmission, and mortality rates were reviewed. Data were analyzed in two groups, one in which physicians accepted all interventions ("accepted") and one in which interventions were rejected ("rejected"). A total of 158 ASP interventions were made. These included carbapenem discontinuation (35%), change to narrower-spectrum antibiotic (32%), dose optimization (17%), further investigations (including imaging and procalcitonin) (11%), infectious diseases referral (3%), antibiotic discontinuation (other than carbapenem) (1%), and source control (1%). Of 220 unique patients, carbapenem use was inappropriate in 101 (45.9%) patients. A significant reduction in carbapenem utilization was observed in the accepted group versus rejected group (median defined daily doses, 0.224 versus 0.668 per 1,000 patientdays, respectively; P Ͻ 0.001). There was a significant reduction in 30-day mortality in the accepted (none) versus rejected group (10 deaths, P ϭ 0.015), but there were no differences in length of stay, hospitalization charge, or 30-day readmission rates. Hypotension was independently associated with mortality in multivariate analysis (odds ratio, 5.25; 95% confidence interval, 1.34 to 20.6). In our institution, acceptance of carbapenem ASP interventions did not compromise patient safety in terms of clinical outcomes while reducing consumption.KEYWORDS antimicrobial stewardship, interventions, pediatric, safety A ntimicrobial stewardship programs (ASPs) promote the judicious use of antimicrobials, in particular, broad-spectrum antimicrobials, such as carbapenems (1). Multiple studies have demonstrated the effectiveness of ASPs in reducing inappropriate antimicrobial use and hospital antimicrobial expenditures, as well as in reducing rates of antimicrobial resistance among health care-associated pathogens (2-4). In addition, the goals of ASPs extend beyond cost-saving strategies, as patient safety, including improvement in patient care and outcomes, is an integral component of antimicrobial stewardship (5).The Infectious Disease Society of America has cited an evaluation of the effective-

show abstract

Section: Discussionsupporting

confidence: 91%

Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes

Seah

Ong

Lim

et al. 2017

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…[7][8][9][10] We believe this gap in the current literature to be important and worthy of exploration because less effective methods of communication for AMS may be detrimental to patient care. In an effort to optimize patient care through our AMS services, we recently retrospectively evaluated the acceptance of all verbal and EMR interventions made by the AMS team at the Providence Veterans Affairs Medical Center between March 1, 2014, and February 28, 2015.…”

Section: Verbal Communication With Providers Improves Acceptance Of Amentioning

confidence: 99%

Verbal Communication With Providers Improves Acceptance of Antimicrobial Stewardship Interventions

Morton

Curzake

Morrill

et al. 2016

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

“…Another method to prevent wrist skin exposure and facilitate doffing employs fingerless cloth gloves attached to the gown sleeve under the gloves. 7 When the user removes their gloves, the hand wear restrains the gown and reduces exposure to the outer contaminated surface of the glove.…”

Section: Seamless Suits: Reducing Personnel Contamination Through Impmentioning

confidence: 99%

“…The density of HBV (10 5-7 virions/mL) in saliva is actually similar to that in semen, 5,6 and the density of HCV (10 6 genome equivalents/mL) in saliva is nearly 10% of that in serum. 7 Furthermore, oral lesions are the most common form of lesions, and oral bleeding is the most common form of bleeding. Unfortunately, all these have been largely neglected.…”

Section: Clinical Guideline Inconsistency Regarding the Prevention Ofmentioning

confidence: 99%

Seamless Suits: Reducing Personnel Contamination Through Improved Personal Protective Equipment Design

Tomas

Cadnum

Mana

et al. 2016

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Impact of an antimicrobial stewardship programme on patient safety in Singapore General Hospital

Cited by 45 publications

References 21 publications

Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes

Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes

Verbal Communication With Providers Improves Acceptance of Antimicrobial Stewardship Interventions

Seamless Suits: Reducing Personnel Contamination Through Improved Personal Protective Equipment Design

Contact Info

Product

Resources

About