Retrospective Evaluation of Pharmacist Interventions on Use of Antimicrobials Using a Clinical Surveillance Software in a Small Community Hospital
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Conflicts of Interest
References
- Centers for Medicaid & Medicaid Services. Hospital Infection Control Worksheet. Available online: https://www.cms.gov/Mediacre/Provider-Enrollment-and-Certification/SurveyCertificationGeInfo/Downloads/Survey-and-Cert-Letter-15-12-Attachment-1.pdf (accessed on 30 August 2016).
- Dellit, T.H.; Owens, R.C.; McGowan, J.E., Jr.; Gerding, D.N.; Weinstein, R.A.; Burke, J.P.; Huskins, W.C.; Paterson, D.L.; Fishman, N.O.; Carpenter, C.F.; et al. Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin. Infect. Dis. 2007, 44, 159–177. [Google Scholar] [CrossRef] [PubMed]
- Barlam, T.F.; Cosgrove, S.E.; Abbo, L.M.; MacDougall, C.; Schuetz, A.N.; Septimus, E.J.; Srnivasan, A.; Dellit, T.H.; F-Ytter, Y.T.; Fishman, N.O.; et al. Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin. Infect. Dis. 2016, 62, 1–27. [Google Scholar] [CrossRef] [PubMed]
- McGregor, J.C.; Weekes, E.; Forrest, G.N.; Perensevich, E.N.; Furuno, J.P.; Harris, A.D. Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: A randomized controlled trial. J. Am. Med. Inform. Assoc. 2006, 13, 378–384. [Google Scholar] [CrossRef] [PubMed]
- Hermsen, E.D.; Van Schooneveld, T.C.; Sayles, H.; Rupp, M.E. Implementation of a clinical decision support system for antimicrobial stewardship. Infect. Control Hosp. Epidemiol. 2012, 33, 412–415. [Google Scholar] [CrossRef] [PubMed]
- Pestotnik, S.L.; Classen, D.C.; Evans, R.S.; Burke, J.P. Implementing antibiotic practice guidelines through computer-assisted decision support: Clinical and financial outcomes. Ann. Intern. Med. 1996, 124, 884–890. [Google Scholar] [CrossRef] [PubMed]
- Evans, R.S.; Pestotnik, S.L.; Classen, D.C.; Clemmewr, T.P.; Weaver, L.K.; Orme, J.F., Jr.; Lloyd, J.F.; Burke, J.P. A computer assisted management program for antibiotics and other antiinfective programs. N. Engl. J. Med. 1998, 33, 232–238. [Google Scholar] [CrossRef] [PubMed]
- Kullar, R.; Golf, D.A.; Schultz, L.T.; Fox, B.C.; Rose, W.E. The “Epic” challenge of optimizing antimicrobial stewardship: The role of electronic medical records and technology. Clin. Infect. Dis. 2013, 57, 1005–1013. [Google Scholar] [CrossRef] [PubMed]
- Optimizing Antimicrobial Stewardship with Sentri7 at Texas Health Arlington Memorial Hospital. Available online: http://wolterkluwer.com/binaries/content/assets/wk-health/pdf/company/newsroom/case-studies/texas-health-arlington.pdf (accessed on 30 August 2016).
- Smith, T.; Philmon, C.L.; Johnson, J.D.; Ward, W.S.; Rivers, L.L.; Williamson, S.A.; Goodman, E.L. Antimicrobial stewardship in a community hospital: Attacking the more difficult problems. Hosp. Pharm. 2014, 49, 839–846. [Google Scholar] [CrossRef] [PubMed]
- Forrrest, G.N.; Schooneveld, T.C.V.; Kullar, R.; Schultz, L.T.; Duong, P.; Postelnick, M. Use of electronic health records and clinical decision support systems for antimicrobial stewardship. Clin. Infect. Dis. 2014, 59, S122–S133. [Google Scholar] [CrossRef] [PubMed]
Pre-Implementation Period | Post-Implementation Period | ||
---|---|---|---|
Total Number of Interventions | |||
(n = 144) | (n = 270) | p # | |
Type of Antibiotic Interventions | |||
Culture surveillance | 11 | 67 | <0.0001 |
Renal Dose adjustment | 128 | 168 | NS * |
Duration of therapy | 3 | 15 | 0.0156 |
Duplicate therapy | 2 | 20 | 0.0006 |
Rule Category | Individual Rules/Medications Include |
---|---|
Culture Surveillance (Drug-Bug Mismatch) | Clostridium difficile positive without oral coverage |
Cefazolin with resistant organism | |
Candida albicans on echinocandins | |
Quinolone with resistant organism | |
Penicillin-sensitive Enterococcus faecalis on vancomycin/linezolid | |
Carbapenem with resistant organism | |
ESBL positive organism without carbapenem | |
Cefepime and cefepime-resistant organism | |
Piperacillin/tazobactam and piperacillin/tazobactam-resistant organism | |
Methicillin-sensitive Staphylococcus aureus on vancomycin/daptomycin/linezolid/tigecycline | |
Ertapenem with Pseudomonas | |
Antibiotic use surveillance # | |
Duration of Therapy | Antimicrobial use >72 h and no signs of infection (T > 38.3 °C, WBC > 12, ANC > 7.5, or Bands > 10%) |
Antimicrobial use >7 days | |
Duplicate Therapy | Anaerobic double coverage |
Concomitant cefepime and levofloxacin >2 days | |
Duplicate beta-lactam use | |
Concomitant piperacillin/tazobactam and levofloxacin >2 days | |
Renal dosing adjustments | Acyclovir, amoxicillin, ampicillin, ampicillin/sulbactam, aztreonam, cefaclor, cefazolin, cefdinir, cefepime, cefotaxime, cefoxitin, ceftazidime, cefuroxime, cephalexin, ciprofloxacin, daptomycin, ertapenem, famciclovir, fluconazole, levofloxacin, meropenem, metronidazole, nitrofurantoin, oseltamivir, piperacillin/tazobactam, sulfamethoxazole/trimethoprim, valacyclovir |
© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Huber, S.R.; Fullas, F.; Nelson, K.R.; Ailts, L.B.; Stratton, J.M.; Padomek, M.T. Retrospective Evaluation of Pharmacist Interventions on Use of Antimicrobials Using a Clinical Surveillance Software in a Small Community Hospital. Pharmacy 2016, 4, 32. https://doi.org/10.3390/pharmacy4040032
Huber SR, Fullas F, Nelson KR, Ailts LB, Stratton JM, Padomek MT. Retrospective Evaluation of Pharmacist Interventions on Use of Antimicrobials Using a Clinical Surveillance Software in a Small Community Hospital. Pharmacy. 2016; 4(4):32. https://doi.org/10.3390/pharmacy4040032
Chicago/Turabian StyleHuber, Samuel R., Fekadu Fullas, Kristel R. Nelson, Lesleigh B. Ailts, James M. Stratton, and Michael T. Padomek. 2016. "Retrospective Evaluation of Pharmacist Interventions on Use of Antimicrobials Using a Clinical Surveillance Software in a Small Community Hospital" Pharmacy 4, no. 4: 32. https://doi.org/10.3390/pharmacy4040032