994. Outcomes of a Pharmacist-Driven Antimicrobial Stewardship Program in a Long-Term Acute Care Hospital Network
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Published studies in antimicrobial stewardship focus on intensive care units of short-term acute care hospitals (STACHs) due to the high density of antimicrobial use in that environment.  Long-term acute care hospitals (LTACHs) receive between 76-96% of their patients directly from STACHs.  At LTACH admission, most patients have already received at least one antimicrobial and many are still on antimicrobials started at the prior facility.  Despite the additional risk of transferring between acute care facilities, there is no published data about antimicrobial stewardship programs (ASPs) in LTACH networks.

Methods: A time-series analysis was applied to 5 years of sequential patient admissions before and after implementation of an ASP in 73 LTACHs nationwide.  Rates of antimicrobial use, pharmacist intervention, and infection (device-associated and Clostridium difficile) were measured, in addition to the percentage of patients who developed sepsis, died, readmitted to STACH, or were discharged to a lower level of care.  Pharmacist satisfaction was measured by turnover and scores on an engagement survey.

Results: Overall antimicrobial use decreased by one-third following implementation of the ASP.  The interrupted time-series model fit the ASP as an abrupt and permanent change.  Prior to the ASP, antimicrobial use was increasing; use dropped after ASP implementation and continued to decrease for the duration of the ASP.  Patient risk, measured by infection, readmission and mortality, either remained stable or significantly decreased; the rate of discharge to a lower level of care increased.  Following the ASP, pharmacists had higher intervention rates, decreased turnover, and higher ratings of positive communications with co-workers, job engagement and value for their supervisors.

Conclusion: An ASP in a nationwide LTACH network was successful in reducing antibiotic use by one-third while maintaining or improving patient and employee outcomes.  STACH ASPs must be adopted by LTACHs and adapted to their unique challenges, such as validating STACH plans of care, evaluating colonization with multi-drug resistant organisms, and finding ways to de-escalate antimicrobials when antibiograms from the referring STACH are unavailable.

Joseph Gastaldo, MD1, Kurt Streepy, RPh, CGP1, Chris Marshall, RPh, MBA1, Amanda Dawson, PhD1, Antony Grigonis, PhD1, Amy Sandhu-Kahn, RPh2, Mary Burkett, RN, MS1 and Lisa Snyder, MD, MPH1, (1)Select Medical, Mechanicsburg, PA, (2)Select Specialty Hospital Northwest Detroit, Detroit, MI

Disclosures:

J. Gastaldo, Select Medical: Consultant, Consulting fee

K. Streepy, Select Medical: Employee, Salary

C. Marshall, Select Medical: Employee, Salary

A. Dawson, Select Medical: Employee, Salary

A. Grigonis, Select Medical: Employee, Salary

A. Sandhu-Kahn, Select Specialty Hospital NW Detroit: Employee, Salary

M. Burkett, Select Medical: Employee, Salary

L. Snyder, Select Medical: Employee, Salary

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.