Category: Professional Posters
Purpose: How to develop a sustainable and effective antimicrobial stewardship practice model. To expand the antimicrobial stewardship program (ASP) using existing resources through the development of a novel pharmacist practice model and leveraging the electronic medical record's functionality. Assess the new model's efficacy based on the impact on antimicrobial usage and hospital-acquired Clostridium difficile infections (HACDI) rates.
Methods: Unit pharmacists underwent a comprehensive and structured in-house training program consisting of didactic lectures, online learning modules, competency assessments, an institution-specific antimicrobial handbook and individualized training with the ASP team consisting of a pharmacist and an infectious disease (ID) physician. Pharmacist received continual mentorship by the ASP team through biweekly prospective audit and feedback reviews to nurture clinical excellence and as quality assurance. Several enhancements were made to the electronic medical record, the most significant being a customized antimicrobial navigator that allows for comprehensive and efficient clinical assessments. Additional modifications included standardized documentation templates, an antimicrobial usage, and HACDI rate dashboard, electronic order sets, and automatic ID consults for restricted antimicrobials.
Results: From implementation of the new model in 2017 until Mar of 2019, antimicrobial usage for all antimicrobials was decreased by 22% (p<0. 001), fluoroquinolones by 21% (p=0. 01), and ceftriaxone by 53% (0<0. 001). HACDI rates decreased from 0. 30 to 0. 16 cases per 1000 patient days (47%, p=0. 12). Since ASP implementation in 2012, total antimicrobial usage has been reduced by 35% (p<0. 01), fluoroquinolones by 73% (p <0. 001), ceftriaxone by 30% (p=0.6) and rates of HACDI by 73% (p<0. 0001).
Conclusion: Developing a comprehensive in-house training program for unit pharmacists in combination with ongoing support from the ASP team provides an effective and sustainable practice model that can greatly improve patient safety.