Supporting Research
Impact of Antimicrobial Stewardship program interventions on costs.
Evidence for Antimicrobial Stewardship was found at: Centers for Disease Control and Prevention
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Impact of Antimicrobial Stewardship program interventions on costs.
Evidence for Antimicrobial Stewardship was found at: Centers for Disease Control and Prevention
Distance need not be a barrier in optimizing antibiotic stewardship, according to a poster about a novel telemedicine program presented at the 2018 ASHP Midyear Clinical Meeting.
Electronic Monitoring – Implementation of a web-based program to provide automated clinical decision support, faciliate approval and real-time communication with prescribers related to antibiotics.
Restriction – Eight IV antibiotics (amikacin, aztreonam, ceftazidime, ciprofloxacin, fluconazole, imipenem-cilastatin, ofloxacin, and ticarcillin-clavulanate, (aztreonam was added to list two months into intervention) previously needed approval, but enforcement of restrictions lax. All staff informed that ID approval needed for dispensement and that pharmacists needed to be informed in writing or by telephone. Enhanced enforcement included issuing warnings to pharmacists if restricted antibiotics dispensed without ID approval.
Electronic Monitoring – randomized controlled trial of active monitoring by antimicrobial management team of all restricted antibiotic orders with a computer system compared to a group without the computer system to alert for inadequate antimicrobial therapy.
Distance need not be a barrier in optimizing antibiotic stewardship, according to a poster about a novel telemedicine program presented at the 2018 ASHP Midyear Clinical Meeting.
Streamlining – Patients on two or more antibiotics identified by computer. After records review for redundant combinations, pharmacist would contact clinician to determine clinical indication and make recommendations for streamlining when appropriate.
Patients with known resistant infections randomized to an intervention consult vs. usual care. Interventional consult done by multidisciplinary team and made recommendations for appropriate therapies while also weighing economic factors of medication.
Distance need not be a barrier in optimizing antibiotic stewardship, according to a poster about a novel telemedicine program presented at the 2018 ASHP Midyear Clinical Meeting.
Multidisciplinary – Three month randomized controlled trial of patients receiving parenteral antibiotics for three or more consecutive days. Intervention group received suggestion for antibiotics from ID and pharmacist. The control did not.
Distance need not be a barrier in optimizing antibiotic stewardship, according to a poster about a novel telemedicine program presented at the 2018 ASHP Midyear Clinical Meeting.
Conversion – CAP pts randomized to conventional course of IV antibiotics vs. abbreviated course of IV antibiotics followed by conversion to oral antibiotics conversion-CAP pts randomized to conventional course of IV antibiotics vs. abbreviated course of IV antibiotics followed by conversion to oral antibiotics.
Conversion – Pharmacists contacted physicians to recommend oral antibiotics conversions from selected broad-spectrum and high-cost parenteral antibiotics for patients with predetermined mild to moderate clinical conditions.
Multidisciplinary – Implementation of new restrictions in antibiotic formulary for broad-spectrum antibiotics and restrictions for antibiotics maximum daily dosage.
Order form – Creation of an order form with preset dosing orders for clindamycin, cefazolin and metronidazole. Physicians still had option to choose own dosing schedule on the form.
Streamlining – Patients on two or more empiric parenteral antibiotics identified by nursing unit pharmacist, results shared with ID physician, who then called prescribing physician to suggest alternative monotherapy.
Restriction-creation of formulary restrictions for vancomycin and select aminoglycocides and cephalosporins, which would require obtaining ID approval for use. ID told not to reject requests but to use persuasion.
Restriction-All physicians wanting to prescribe cephalexin had to seek approval from ID physician.
Guidelines – Establishment of guidelines that cefazolin is cephalosporin of choice. Physicians contacted if orders deemed to be noncompliant.
Guidelines – Established restrictions on use of 2nd generation cephalosporins and aminoglycosides requiring obtaining pharmacy approval before drug disbursement