Formulary restriction and preauthorization of antimicrobial use are core components of antimicrobial stewardship programs. While several studies have demonstrated the positive impact of antimicrobial restriction policies and procedures, there is limited guidance on the optimal criteria and measures needed to develop an effective process and ensure adherence to the established policy.
All orders for restricted antimicrobial agents over a 1-month period were identified for inclusion in the retrospective study. Overall adherence to the institution’s antimicrobial restriction policy was determined. Reasons for and consequences of non-adherence were evaluated.
A total of 254 orders for restricted antimicrobial agents in 117 patients were included in the analysis. The majority of orders were prescribed by a Medicine (38%) or Intensive Care Unit (33%) service. Meropenem (45%), linezolid (13%), and daptomycin (10%) were the most common restricted antibiotics requested. Only one-third of all orders were entered and processed in complete accordance with the institution’s policy. More than half of all orders were entered prior to receipt of approval by an Infectious Diseases provider as required per policy. Non-adherence to the policy was associated with delays in order processing and initiation of therapy, as well as significant communication between the pharmacist, ordering provider, and Infectious Diseases physician.
Adherence to an institution’s long-standing antimicrobial restriction policy was poor, and associated with delays in therapy and increased workload. Strategies for effective development and implementation of antimicrobial restriction and preauthorization policies must be defined to ensure optimal antimicrobial use.
S. P. Jen,
S. Swaminathan, None
D. Cennimo, None
R. Kapila, None