Abstract
Abstract Objectives The aim was to conduct a pilot study to determine staff resource requirements for an antimicrobial stewardship (AMS) ward round informed by electronic prescriptions, and the number of restricted antimicrobial prescriptions that would prompt a ward round recommendation. Methods Prescription data on 26 restricted antimicrobial agents (which have specific prescribing criteria defined by the national drug funding agency) were extracted from the electronic prescribing and administration system (MedChart). A language query was used for specific antimicrobial names on Mondays, Wednesdays, and Fridays over 4 weeks. Prescriptions that had ceased or had an appropriate indication documented were excluded. The remaining prescriptions were evaluated in the ward round upon clinical record review with theoretical AMS recommendations made and time requirements recorded. The ward rounds were performed by two clinical staff, a doctor and pharmacist. Results In 12 days, 622 prescriptions were extracted. Of these, 66 were evaluated in ward rounds, with 67% (44/66) being for ciprofloxacin or piperacillin-tazobactam. Theoretical AMS recommendations were made in 61% (40/66) of cases, 45% (18/40) being to use a narrower spectrum agent, 30% (12/40) to consult the Infectious Diseases Service, and 23% (9/40) to stop antimicrobial therapy. Data extraction took an analyst approximately 15 minutes, screening by a doctor approximately 20 minutes, and ward rounds approximately 41 minutes per day. Conclusion Our approach required, in total, approximately 100 clinical staff minutes per day to screen approximately 50 prescriptions and identify and evaluate approximately four prescriptions and showed clinical value. Resource planning should also consider Infectious Diseases and/or Microbiology (physician and service) involvement, and audit capability.
Highlights
Background and SignificanceObjectivesThe emergence and spread of resistant microorganisms is a “global crisis” that is “one of the greatest threats to health.”[1]
The inclusion criteria for this feasibility study were adult inpatients 18 years of age admitted under a medical or surgical service at the Christchurch Hospital campus who were electronically prescribed one or more of 26 selected restricted antimicrobial agents (►Fig. 1). Excluded patients were those in the Emergency Department or Intensive Care Unit (e-PA not implemented in these services), or under the care of the Respiratory, Hematology, or Pediatric and Neonatal services
Prescriptions Excluded from the antimicrobial stewardship (AMS) Ward Rounds (n 1⁄4 556) ►Fig. 1 and ►Table 2 show the number of excluded prescriptions at each step of the screening process, from data extraction until inclusion in the ward rounds
Summary
Background and SignificanceObjectivesThe emergence and spread of resistant microorganisms is a “global crisis” that is “one of the greatest threats to health.”[1]. Key international organizations, including the Infectious Diseases Society of America with the Society for Healthcare Epidemiology of America, have released recommendations for the structure and implementation of AMS programs within health care institutions.[6] Two major approaches recommended for optimizing antimicrobial prescribing in the hospital setting are formulary restriction with preauthorization for use of certain antimicrobial agents (a restrictive “front-end” strategy), and prospective audit with intervention and feedback (a persuasive “back-end” strategy). Both methods improve outcomes related to antimicrobial use including the appropriateness of prescribing, and reduce occurrence of infections caused by Clostridium difficile and multidrug-resistant bacteria.[6,7]
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