Antimicrobial Prescribing in a Rapid Assessment Medical Unit – A Multi‐Phase Pilot Study

Abstract

ABSTRACTBackgroundIncreased awareness of antimicrobial resistance has resulted in the introduction of institutional antimicrobial stewardship programs.AimTo evaluate antimicrobial prescribing in a Rapid Assessment Medical Unit (RAMU) after the introduction of an antimicrobial stewardship pharmacist (ASP) and antimicrobial stewardship team (AST); and to review acceptance rates of recommendations on antimicrobial prescribing made by a ward pharmacist, ASP and AST.MethodData were collected over a 4‐week period for all patients admitted to the RAMU and prescribed antimicrobials. Weeks 1 and 4 acted as controls. During Week 2 the ASP and during Week 3 the AST reviewed the restricted antimicrobials prescribed daily. Recommendations were recorded concurrently and medication charts were reviewed to determine if these were accepted. Appropriateness of antimicrobial prescribing was assessed retrospectively over the 4 weeks by the ASP and an infectious diseases physician.Results137 patients were eligible and 344 antimicrobials were evaluated. Antimicrobial prescribing varied over the 4 weeks but improved significantly with the ASP (vs standard care; p = 0.006) and AST reviews (vs standard care; p = 0.03). Treating teams were more likely to accept recommendations made by the AST than the ward pharmacist or the ASP.ConclusionIntroduction of a AST in a RAMU improved antimicrobial prescribing. Recommendations made by the AST were accepted more often than those made by a pharmacist with or without formal infectious disease training.