Divide and conquer: Feasibility and Impact of antimicrobial stewardship in a safety‐net community hospital after a syndrome‐based education initiative for pharmacists

Abstract

AbstractIntroductionAntimicrobial stewardship programs (ASP) have been shown to reduce antimicrobial utilization (AU) and cost. ASP has been required by the Joint Commission for hospital accreditation since 2017. Community hospitals with limited pharmacy staffing and infectious diseases (ID)‐trained pharmacists may have barriers for implementing and sustaining comprehensive ASP.ObjectivesOur objective was to assess the feasibility and impact of syndrome‐based ASP training on pharmacist knowledge, perceptions, and AU in a community hospital with limited pharmacy staff.MethodsA quasi‐experimental study at a 151‐bed hospital was conducted. Pharmacist training on syndrome‐based guidelines was developed by an ID physician. A qualitative cross‐sectional survey to assess pharmacist knowledge and perceptions of ASP was administered before and 3 months after ASP training. Prospective audit and feedback (PAF) were deployed with responsibilities divided between shifts. The Centers for Disease Control and Prevention (CDC) checklist of core elements was done quarterly for 12 months. AU, Clostridium difficile rates, and cost were compared for 12 months before and after implementation.ResultsMost pharmacists did not feel comfortable managing infections before ASP training. All pharmacists found the guidelines helpful and felt more comfortable managing infections at 3 months. ASP was successfully deployed by dividing tasks between shifts. Days of therapy per 1000 patient days increased from 355.5 to 376. The proportion of parenteral antimicrobials decreased from 71% to 65%.Total antimicrobial expenditures decreased by 23%. C. difficile rates decreased by 21% (3.27 vs 2.56) per 10 000 patient days.ConclusionASP was successfully implemented in a safety‐net community hospital without ID‐trained pharmacists using a syndrome‐based education initiative. This strategy improved pharmacist knowledge and perceptions of ID syndromes and ASP. Dividing tasks between shifts can leverage existing resources to fulfill all core elements. Clear guidelines and access to an ID physician are necessary to develop materials and provide support for pharmacists without ID‐specific training and can help curb costs and optimize AU.