The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

Abstract

Background: In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services. Methods: This single-center, quasi-experimental study included data from weekends before (9/2017–11/2017) and after (9/2018–11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes. Results: During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes. Conclusion: Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services.

Using a Knowledge-Based Clinical Decision Support System to Reduce the Time to Appropriate Antimicrobial Therapy in Hospitalized Patients With Bloodstream Infections: A Single-Center Observational Study

“…Previous reports also showed that time to antibiotic tailoring and responses to culture results were slower outside working hours [ 25 , 26 ]. Bohn and colleagues expanded antimicrobial stewardship service to include weekends at a medical center and significantly reduced the time to resolution of antimicrobial stewardship opportunities [ 27 ]. Our results demonstrated that an active-delivery CDSS could remarkably decrease TAAT during off hours without increasing any workforce.…”

Evaluation of Critical Care Pharmacist Evening Services at an Academic Medical Center

“…5 For example, when pharmacy-driven antimicrobial stewardship services were expanded to weekends in a cohort of medicine patients, a decreased time to both escalation and de-escalation of antimicrobials was achieved. 10 Studies assessing the impact of expanding emergency department pharmacy services to 24 hours have reported decreased medication errors, improvement in medication reconciliations, improved staff satisfaction, and increased cost savings. 11,12 Multiple studies have also demonstrated improved perceptions of quality of care when evening shift pharmacist are included.…”