Program Schedule

Early Impact of a Pharmacist-led Antimicrobial Stewardship Program Conducted without Clinical Decision-support Software at a Community Teaching Hospital

Session: Oral Abstract Session: New Approaches to Antibiotic Stewardship
Friday, October 10, 2014: 9:30 AM
Room: The Pennsylvania Convention Center: 107-AB
Background: Antimicrobial stewardship programs (ASPs) have shown to reduce antimicrobial utilization, improve patient outcomes, and decrease healthcare-associated infections such as Clostridium difficile (CDI).  Many institutions utilize clinical-decision-support systems (CDSS) to help implement ASPs and streamline daily activities. Community hospitals may be resource-limited and often must conduct ASPs without CDSS.   We describe the early outcomes of a pharmacist-led ASP at a community teaching hospital without CDSS.

Methods: An ASP was established at a 280-bed community teaching hospital in July, 2013, led by an infectious diseases-trained pharmacist.  Baseline needs assessment, antibiogram and empiric therapy guideline development, and hospital-wide prescriber and pharmacist education occurred between July and October, 2013.  Prospective audit with intervention and feedback (PAIF) was conducted by the ASP pharmacist beginning in October, 2013, using a daily computer-generated list of all patients receiving antimicrobials.   All patients reviewed by the ASP pharmacist from October 1, 2013 through March 31, 2014 were included in the analysis.  Monthly utilization of antimicrobials was calculated using Defined Daily Doses (DDD) per 1000 patient days and CDI rates were characterized per 10,000 patient days. The ASP period was compared with a cohort of 12 months immediately prior to initiating the ASP. 

Results: In the first six months of PAIF implementation 7,503 charts were reviewed, with an average of 61 patients per day; 1,575 interventions were recommended with an acceptance rate of 91% (n = 1,433).  The most common interventions were de-escalation/discontinuation of antibiotics (49%), IV to PO (17%), and dose optimization (14%). Carbapenem utilization decreased by 64% (meropenem DDD mean: 21 vs 7.5, p < 0.001; ertapenam DDD mean: 8 vs 3, p < 0.001) while levofloxacin utilization decreased by 49% (DDD mean: 66 vs 34, p < 0.001) CDI rates decreased by 32% (mean cases per 10,000 patient days 17 vs 11.4; p = 0.028).   

Conclusion: A pharmacist-led ASP in a community teaching hospital without CDSS significantly impacted antimicrobial prescribing, reducing antimicrobial utilization and CDI rates.

Lisa Dumkow, Pharm.D., Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI, Minerva Galang, MD, Infectious Diseases, Saint Mary's Health Care, Grand Rapids, MI and Nnaemeka Egwuatu, MD, MPH, Infectious Diseases, Mercy Health Saint Mary's, Grand Rapids, MI


L. Dumkow, None

M. Galang, None

N. Egwuatu, None

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