Category: Professional Posters
Purpose: Published data on successful Antimicrobial Stewardship Programs (ASP) often pertain to large medical centers with dedicated ASP pharmacists, often with advanced formal infectious disease (ID) training. However, most small hospitals with less than 200 beds are lacking an ID-trained pharmacist or full-time ASP pharmacist, presenting a challenge to establish and maintain an effective ASP. This observational study describes the utilization of a non-ID trained pharmacist once weekly to implement ASP at a small hospital and its positive impact on antimicrobial utilization.
Methods: A part-time pharmacist (0.2 full-time equivalent) with postgraduate year 1 training was employed to implement an early stage of ASP at a 128-bed community hospital on July, 2016. Multidisciplinary support from administration, an ID physician, pharmacy and nursing was available, but consistent ASP activities were not in place. Once weekly (e.g. 8 hours per week), the ASP pharmacist reviewed electronic health records (EHR) for patients receiving systemic antimicrobials for >48 hours, initially for respiratory tract and urinary tract infections. After 6 months, EHR reviews included antimicrobial use for all infections. The ASP pharmacist identified antimicrobial-related issues based on ASP principles and best practices, and communicated recommendations to the ordering providers via various processes such as writing ASP progress notes or direct prescriber contact. In order to establish the credibility of the ASP pharmacist, all recommendations were subsequently reviewed by the ID physician for one year. The ID physician’s agreement to ASP pharmacist’s recommendations exceeded greater than 95%. Total recommendations to prescribers were tracked by the ASP pharmacist. Recommendations were considered “accepted” if enacted by the end of the following inpatient day. Additionally, the ASP pharmacist reported details of interventions/outcomes, assisted in educational efforts for providers, participated in order set revision, and performed drug use evaluations for broad spectrum antimicrobials.
Results: From August 2016 to December 2018, the ASP pharmacist made a total of 480 recommendations with an increasing average number per month of 9.4 in 2016, 13.4 in 2017 and 22.7 in 2018. The acceptance rate was also improved from 57.4% in 2016, to 72.7% in 2017, and 68.0% in 2018. Days of Therapy (DOT)/1000 patient days for all antimicrobials decreased by 25.5% during this time (876.4 in 2016, 676.1 in 2017 and 652.8 in 2018), indicating overall improvement of antimicrobial utilization. Particularly, DOT/1000 patient days for meropenem and vancomycin were reduced from 21.4 and 91.9 respectively in 2016 to 8.7 and 58.1 in 2018, while that of piperacillin/tazobactam slightly increased from 67.5 in 2016 to 71.7 in 2018.
Conclusion: Consistent utilization of a once weekly non-ID trained pharmacist in conjunction with an active ID physician and administrative support was a successful practice model to implement ASP and to improve overall antimicrobial utilization in a small community hospital setting with limited resources.