Role of the Pharmacist in Antimicrobial Stewardship

Parente, Diane M.; Morton, Jacob

doi:10.1016/j.mcna.2018.05.009

Cited by 47 publications

(34 citation statements)

References 21 publications

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“…Logistic regression analysis revealed that managers and licensed pharmacists have a better understanding of antimicrobial policies (OR 22.568, 95% CI 1.281-397.537, P = 0.033; OR 46.327, 95% CI 2.443--878.451, P = 0.011) and independent pharmacy (OR 0.016, 95% CI 0.007-0.037, P < 0.001) mainly acquire antimicrobialrelated knowledge through pharmacy training. Previous studies have shown that pharmacist-driven antimicrobial stewardship in an intensive care unit could decrease patient mortality and the emergence of multidrug resistance and optimize antimicrobial usage [50][51][52]. Hence, pharmacies should pay attention to prospective employees' education levels, and they should have licensed pharmacists on duty according to government requirements, which will help with the implementation of ASPs.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China

Feng

Hayat

Zhe

et al. 2020

Expert Review of Anti-infective Therapy

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Background: Antimicrobial resistance is one of the most significant challenges of the twenty-first century, and the illegal sale of antimicrobial drugs at community pharmacies is a driver of antimicrobial resistance. This study explores the knowledge, attitudes, and practices (KAP) of pharmacy staff toward antimicrobial stewardship programs (ASPs). Methods: We conducted a descriptive cross-sectional study among community pharmacy staff in Northeastern China, from April 1 to 31 May 2019, using a self-administered KAP questionnaire comprising 20 items. The data analysis was carried out by employing Mann-Whitney and Kruskal-Wallis tests. Results: A response rate of 98.5% (394/400) was obtained. The majority of participants (94.9%) demonstrated a good understanding of antimicrobial use, but they lacked an adequate understanding of ASPs. Nearly half of the participants (40.6%) reported that they sold antimicrobials to patients without a prescription. Education level, age, occupation, and experience were all significantly associated (P < 0.05) with participants' median ASPs scores. Besides, the presence of a licensed pharmacist (OR 46.327, 95% CI 2.443-878.451, P = 0.011) was the main factor associated with the pharmacy staff's understanding of antimicrobial use policies. Conclusions: The participants' knowledge of antimicrobials was good, and their attitudes regarding ASPs were positive, but their practices regarding ASPs were poor.

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Section: Discussionmentioning

confidence: 99%

Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China

Feng

Hayat

Zhe

et al. 2020

Expert Review of Anti-infective Therapy

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“…Additionally, a wide variety of practice locations and roles are represented. Pharmacists were surveyed rather than other health care professionals, such as physicians and advanced practice providers, because they are often the driving forces behind AMS efforts and education on medication‐related adverse effects . The focus of this survey was on perceptions as well as practices, though the behaviors associated with those perceptions may be discordant at times.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacists who believe combination VPT is associated with AKI more frequently discourage empiric use of the combination, although these decisions may also reflect institution-and intensive care unit providers, because they are often the driving forces behind AMS efforts and education on medication-related adverse effects. 26,27 The focus of this survey was on perceptions as well as practices, though the behaviors associated with those perceptions may be discordant at times. This may be especially true for pharmacists who practice at an institution with policies or pathways that do not align with their perceptions of combination VPT and AKI development.…”

Section: Discussionmentioning

confidence: 99%

Pharmacists' perceptions and practice changes resulting from emergence of the vancomycin‐piperacillin/tazobactam nephrotoxicity phenomenon

Hammond

Trivedi

Esmero

et al. 2019

J Am Coll Clin Pharm

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Purpose To elucidate the considerations pharmacists have when using concomitant vancomycin and piperacillin/tazobactam (VPT) and strategies implemented across hospitals in response to published data on this phenomenon. Methods A survey of pharmacist members of the infectious diseases and critical care (CC) practice and research networks of the American College of Clinical Pharmacy was conducted. Participants were grouped based on their belief (yes or no) in the association between VPT and acute kidney injury (AKI) and queried regarding AKI with VPT, antimicrobial stewardship practices, and demographics. Descriptive statistics were performed. Between‐group responses were compared using χ2 or Fisher's exact tests. Results There were 238 responses. Most (88.7%) respondents believed combination VPT is associated with greater expected odds of AKI development than vancomycin monotherapy or with cefepime. Nonbelievers more commonly practiced in CC or emergency medicine (P = .006) and less frequently recommended the combination in patients already experiencing AKI (64% vs 7.4%, P < .001) and in patients with chronic kidney disease class III or IV (56.9% vs 3.7%, P < .001). Opinions varied regarding risk factors for and odds of AKI development in specific scenarios. Respondents who believed combination VPT is associated with greater odds of AKI development more frequently provided formal (18% vs 0, P = .01) and informal (73% vs 33.3%, P < .001) education on potential AKI from combination VPT and discouraged empiric combination VPT in favor of other combination(s) (40.8% vs 14.8%, P = .01). Other AMS strategies were used to a similar extent regardless of belief in the association of VPT with AKI. Conclusion Most respondents, particularly those practicing in CC and emergency medicine, believe combination VPT is associated with AKI development. These beliefs have affected antimicrobial recommendations and educational efforts. The impact of these beliefs on patient outcomes and health care expenditures requires further investigation.

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“…Antimicrobial stewardship programmes in hospitals have led to a decrease in resistance rates and improvements in patient outcomes; however, less is known regarding the effectiveness of different types of programs in the outpatient setting 8,9 . Several successful ambulatory antimicrobial stewardship (AAMS) interventions have led to improvements in prescribing practices including clinician education, using electronic health records (EHRs) to modify prescribing habits, justification screens for clinicians when prescribing antibiotics and signed commitments posted in patient rooms 10‐12 .…”

Section: What Is Known and Objectivementioning

confidence: 99%

Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections

et al. 2020

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What is known and Objective Currently, there are limited data on ambulatory antimicrobial stewardship (AAMS) programmes in the primary care setting. The purpose of this study was to implement a pharmacist‐led AAMS programme for uncomplicated cystitis (UC) and pyelonephritis in a hospital‐based family medicine residency clinic. Methods A retrospective cohort study was used to assess clinician prescribing habits and identify areas of inappropriate prescribing. Females between 18 and 64 years old diagnosed with UC or pyelonephritis were included in the analysis. The primary objective was a composite of appropriate choice of antibiotic based on first‐line recommendations, appropriate dose and appropriate duration of therapy. The intervention included development of a guideline‐based antibiotic treatment summary accessible in the electronic health record (EHR), clinician education sessions for medical residents and faculty, and treatment defaults in the EHR. Results and Discussion Eighty‐one patients were included in the pre‐intervention group and 81 in the post‐intervention group. In the pre‐intervention group, 37% of patients met the composite primary outcome vs. 71.6% in the post‐intervention group (P < .001) for UC and pyelonephritis combined. This was primarily driven by improvement in appropriate duration of therapy for both diagnoses which increased from 44.4% to 84.0% (P < .001). What is new and Conclusions A pharmacist‐led AAMS programme significantly improved guideline‐based treatment adherence for UC and pyelonephritis based on the composite of appropriate choice of antibiotic, appropriate dose and appropriate duration of therapy in a primary care family medicine setting.

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Role of the Pharmacist in Antimicrobial Stewardship

Cited by 47 publications

References 21 publications

Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China

Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China

Pharmacists' perceptions and practice changes resulting from emergence of the vancomycin‐piperacillin/tazobactam nephrotoxicity phenomenon

Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections

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