Impact of the expansion of antimicrobial stewardship services during transitions of care at an academic hospital

Zampino, Stephanie T.; Politis, Paula; Fosnight, Susan M.; File, Thomas M.; Gothard, M. David

doi:10.1017/ice.2020.216

Cited by 7 publications

(17 citation statements)

References 4 publications

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“…Pharmacists practicing in antimicrobial stewardship, emergency department, general medicine, and outpatient settings have played essential roles in ASP during TOC (Table 4). 19,20,24,26‐31 Workflows and checklists for pharmacists were integrated into multiple ASP TOC care models. A common approach for antimicrobial review is providing audit and feedback in real‐time once a prescription has been entered or signed.…”

Section: Interventions and Pharmacist Role In Stewardship At Tocmentioning

confidence: 99%

“…Zampino et al expanded ASP services for discharge antibiotic from medical/surgical wards by having an ASP pharmacist provide audit and feedback at the time of discharge. Even when the discharge prescriptions have already been entered and ordered, this program was able to improve appropriateness of therapy from 47.5% to 85.2% 28 . On a statewide scale, Vaughn et al directed 41 centers in Michigan in an intervention for reporting and benchmarking antibiotic prescribing for community‐acquired pneumonia.…”

Section: Measuring Successes and Challenges In A Toc Modelmentioning

confidence: 99%

“…Over the study period, duration of antibiotic and frequency of adverse events decreased 36 . The clinical impact on safety and patient‐centered outcomes will prove to be critical in future efforts in advocacy for ASP TOC support, with authors reporting improvements in quality or prescribing, adverse events, and even possibly readmissions 28,31,36 …”

Section: Measuring Successes and Challenges In A Toc Modelmentioning

confidence: 99%

“…4). 19,20,24,[26][27][28][29][30][31] Workflows and checklists for pharmacists were integrated into multiple ASP TOC care models. A common approach for antimicrobial review is providing audit and feedback in real-time once a prescription has been entered or signed.…”

Section: Interventions and Pharmacist Role In Stewardship At Tocmentioning

confidence: 99%

“…Even when the discharge prescriptions have already been entered and ordered, this program was able to improve appropriateness of therapy from 47.5% to 85.2%. 28 On a statewide scale, Vaughn et al directed 41 centers in Michigan in an intervention for reporting and benchmarking antibiotic prescribing for community-acquired pneumonia. Over the study period, duration of antibiotic and frequency of adverse events decreased.…”

Section: Measuring Successes and Challenges In A Toc Modelmentioning

confidence: 99%

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Transitions of care: An untapped opportunity for antimicrobial stewardship

Patel

Davis

MacDonald

et al. 2022

J Am Coll Clin Pharm

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Over half of antimicrobials ordered at hospital discharge are not optimized, many of which having longer than necessary durations or inappropriate for the indication.Unnecessary antimicrobial exposures increase the risks of adverse events, antibiotic resistance, and Clostridioides difficile infections. However, discharge prescribing often escapes the purview of inpatient antimicrobial stewardship programs and few interventions have been implemented to optimize antibiotic use during transitions of care (TOC). Herein, the aim was to highlight critical steps and challenges in the implementation of a TOC antimicrobial stewardship program designed to improve prescribing at hospital discharge. In a five-hospital health system, a pharmacist-led intervention was implemented during TOC, with the objective of improving oral antibiotic selection and duration. Among a multidisciplinary team of physicians, case managers, and nurses, the pharmacists engaged in three strategies: (a) early identification of patients to be discharged on oral antibiotics; (b) collaborative planning and communication regarding guideline-recommended antibiotic selection and duration; and (c) facilitation of discharge antibiotic prescription with appropriate stop date. Barriers to completing the intervention on each patient in this experience included: timely identification of eligible patients prior to discharge, stewardship periods of reduced staffing during evenings and weekends, and onboarding of new staff and trainees to the process. Other major challenges that stewardship and pharmacy departments will face include adoption of best-practice guidelines for discharge, obtaining support from local physician champions, extending the intervention to various service lines and departments with limited resources, and engaging stakeholders to support the program and intervention. This experience demonstrated that pharmacist-led antimicrobial stewardship at discharge can be successful in both academic and community settings.

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Section: Interventions and Pharmacist Role In Stewardship At Tocmentioning

confidence: 99%

Section: Measuring Successes and Challenges In A Toc Modelmentioning

confidence: 99%

Section: Measuring Successes and Challenges In A Toc Modelmentioning

confidence: 99%

Section: Interventions and Pharmacist Role In Stewardship At Tocmentioning

confidence: 99%

Section: Measuring Successes and Challenges In A Toc Modelmentioning

confidence: 99%

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Transitions of care: An untapped opportunity for antimicrobial stewardship

Patel

Davis

MacDonald

et al. 2022

J Am Coll Clin Pharm

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Pharmacist-Driven Transitions of Care Practice Model for Prescribing Oral Antimicrobials at Hospital Discharge

et al. 2022

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IMPORTANCEAlthough prescribers face numerous patient-centered challenges during transitions of care (TOC) at hospital discharge, prolonged duration of antimicrobial therapy for common infections remains problematic, and resources are needed for antimicrobial stewardship throughout this period.OBJECTIVE To evaluate a pharmacist-driven intervention designed to improve selection and duration of oral antimicrobial therapy prescribed at hospital discharge for common infections. DESIGN, SETTING, AND PARTICIPANTSThis quality improvement study used a nonrandomized stepped-wedge design with 3 study phases from September 1, 2018, to August 31, 2019. Seventeen distinct medicine, surgery, and specialty units from a health system in Southeast Michigan participated, including 1 academic tertiary hospital and 4 community hospitals. Hospitalized adults who had urinary, respiratory, skin and/or soft tissue, and intra-abdominal infections and were prescribed antimicrobials at discharge were included in the analysis. Data were analyzed from

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Assessment of antibiotic appropriateness at discharge: experience from a quaternary care hospital setting

Saleh¹,

Nekidy

El-Lababidi³

2022

JAC-Antimicrobial Resistance

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Background There is a gap in antimicrobial stewardship in transitions of care. Objectives To assess the appropriateness of antibiotics utilized and prescribing habits at hospital discharge. Methods A retrospective, observational study was conducted at our quaternary care hospital between January 2021 and March 2021. During the study period, all patients discharged on antibiotics for pneumonia (PNA), skin and soft tissue infections (SSTI), urinary tract infections (UTI) and intra-abdominal infections (IAI) were included. The overall appropriateness of therapy was assessed based on the following combined criteria: agent, dose, frequency, duration of therapy, and ability to meet diagnostic criteria. Results One hundred and forty-five subjects met the inclusion criteria. Of these, 44 (30.3%) were determined to have received overall appropriate antibiotic therapy. The most common infections were UTI, followed by IAI, PNA, and SSTI, respectively. Further, from the group deemed to have received overall inappropriate therapy, 26 of the 101 (25.7%) patients received an inappropriate antibiotic choice, 6 (5.9%) an inappropriate dose, and 84 (83.2%) an inappropriate duration of therapy. Conclusions Inappropriate duration of therapy represented the most challenging problem with antibiotic regimens at discharge. Larger studies are needed to identify potential interventions that are effective, and can be implemented in all settings, including resource-limited ones.

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Impact of the expansion of antimicrobial stewardship services during transitions of care at an academic hospital

Cited by 7 publications

References 4 publications

Transitions of care: An untapped opportunity for antimicrobial stewardship

Transitions of care: An untapped opportunity for antimicrobial stewardship

Pharmacist-Driven Transitions of Care Practice Model for Prescribing Oral Antimicrobials at Hospital Discharge

Assessment of antibiotic appropriateness at discharge: experience from a quaternary care hospital setting

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