Transition from a dedicated to a non-dedicated, ward-based pharmacist antimicrobial stewardship programme model in a non-academic hospital and its impact on length of stay of patients admitted with pneumonia: a prospective observational study

Abstract

Pharmacists play an integral role in antimicrobial stewardship (AS). Some AS programmes employ dedicated pharmacists, sometimes with infectious diseases (ID) training, while others employ ward-based pharmacists. The role and impact of both are under investigation. This study compares the length of stay (LOS) of patients admitted to hospital with community-acquired pneumonia (CAP) after the implementation of an AS programme initially led by a dedicated ID-trained pharmacist, and then transitioned to a ward-based pharmacist. Starting 1 April 2013, all adult patients admitted with CAP were prospectively reviewed by the AS programme. The control period (phase 0) lasted 3 months. Thereafter, AS was implemented in each of four medicine wards at 2-month intervals in a staggered fashion. During this period (phase 1), an ID-trained pharmacist and physician performed daily prospective audit and feedback. After 24 months, ward-based pharmacists assumed this AS role (phase 2). Over the 36-month study period, 1125 patients with CAP were entered into the AS database, with 518 and 247 patients receiving an AS audit and feedback in phases 1 and 2, respectively. The acceptance rate for AS recommendations was similar for phases 1 and 2, each exceeding 82%. After accounting for secular trends, the overall reduction in LOS was 19.4% (95% CI 1.4% to 40.5%). There was no difference in LOS between phases 1 and 2. This study demonstrated that an AS audit and feedback intervention reduced the median LOS in patients with CAP by approximately 0.5 days regardless of pharmacist model. However, fewer patients were exposed to the AS intervention in phase 2, suggesting dedicated AS pharmacists may be necessary to realise the full benefits of AS.

The need for an antibiotic stewardship program in a hospital using a computerized pre-authorization system

“…In a meta-analysis, it was shown that interventions reduced LOS by 1.12 days (Davey et al, 2013). In another study, it was demonstrated that a prospective audit and feedback intervention reduced median LOS in patients with community-acquired pneumonia by nearly 0.5 days (DiDiodato and McAthur, 2017). The overall reduction in LOS was 19.4%.…”

Antimicrobial Stewardship Programs in Northwest China: A Cross-Sectional Survey of Perceptions, Involvement, and Perceived Barriers Among Hospital Pharmacists

“…The acceptability, importance, and implementation of hospital-based AMS programs across different hospital settings is well-described in the literature due to their acknowledged benefits ( Brotherton, 2018 ; Chen et al, 2018 ; Burgess et al, 2019 ; Onorato et al, 2020 ). Numerous developed countries, including the United States, United Kingdom, Australia, and Canada, have implemented AMS programs successfully ( Seo et al, 2016 ; Charani et al, 2017 ; DiDiodato and McAthur, 2017 ; Rautemaa-Richardson et al, 2018 ; Cipko et al, 2020 ); however, its implementation in developing countries is challenging ( Hayat et al, 2020 ). It has been proven that pharmacist-driven AMS is beneficial in reducing the duration of antimicrobial treatment, shortening hospital stays, lowering patient mortality, optimizing antimicrobials use, and limiting the emergence of multidrug-resistant organisms ( Li et al, 2017 ; Parente and Morton, 2018 ; Wang et al, 2019 ; Sadyrbaeva-Dolgova et al, 2020 ; Takito et al, 2020 ).…”

A narrative review of antimicrobial stewardship interventions within in-patient settings and resultant patient outcomes

“…[ 33 34 35 ] In two studies, prospective audit is used as an intervention to control the antimicrobial cost of treatment. [ 36 37 ] A study being performed in the Tokyo Metropolitan Hospital in Japan using prospective audit intervention to control the resistant Gram-negative bacilli (GNB) infection found a significant ( P < 0.01) fall of carbapenem resistance in Pseudomonas aeruginosa . [ 38 ] In an ID physician-led community hospital AMS program where the ID physician closely monitored the susceptibility and cost patterns of antimicrobial practice showed a remarkable improvement in controlling the AMR and cost within the hospital.…”