Retrospective Evaluation of Pharmacist Interventions on Use of Antimicrobials Using a Clinical Surveillance Software in a Small Community Hospital.

Samuel Huber,James Stratton,Fekadu Fullas,Kristel Nelson,Lesleigh Ailts,Michael Padomek

doi:10.3390/pharmacy4040032

Abstract

The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America “Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship” recommend the use of computer-based surveillance programs for efficient and thorough identification of potential interventions as part of an antimicrobial stewardship program (ASP). This retrospective study examined the benefit of utilizing a clinical surveillance software program to help guide antimicrobial therapy in an inpatient setting, in a small community hospital, without a formal ASP. The electronic health record (EHR) was used to retrieve documentations for the following types of antibiotic interventions: culture surveillance, duplicate therapy, duration of therapy and renal dose adjustments. The numbers of interventions made during the three-month periods before and after implementation of the clinical surveillance software were compared. Antibiotic related interventions aggregated to 144 and 270 in the pre- and post-implementation time frame, respectively (p < 0.0001). The total number of antibiotic interventions overall and interventions in three of the four sub-categories increased significantly from the pre-implementation to post-implementation period. Clinical surveillance software is a valuable tool to assist pharmacists in evaluating antimicrobial therapy.

Highlights

Antimicrobial stewardship has been gaining attention as infections caused by multidrug resistant organisms and costs associated with antibiotic use escalate across the country
The purpose of this study is to evaluate the impact of a clinical surveillance software Sentri7® on the number of interventions made by pharmacists at a community hospital without an established antimicrobial stewardship program (ASP)
In the pre-implementation period, 10 antibiotic interventions were excluded for lack of information and 89 were excluded due to being physician-initiated

Summary

Introduction

Antimicrobial stewardship has been gaining attention as infections caused by multidrug resistant organisms and costs associated with antibiotic use escalate across the country. The Infectious Diseases Society of America (IDSA) has published two different guidelines on antimicrobial stewardship [2,3]. Both guidelines recommend the use of clinical decision-support and surveillance programs. Current studies that focus on the use of surveillance programs have been conducted at academic medical centers with an established ASPs [4,5]. These studies have shown decreased antibiotic costs [4] and an upsurge of interventions [4,5]. In a study that covered antibiotic use over a seven-year period, Pestotnik et al [6] demonstrated a decrease in antibiotic cost and antibiotic-associated adverse drug events with the use of antibiotic management support programs

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