Prospective-audit-with-feedback and pre-authorization and/or formulary restriction are two highly effective core strategies for antimicrobial stewardship programs (ASPs). Singly or in combination, these strategies decrease use to reported means of 787 days of therapy per 1000 patient days (DOT/1000 PD). We describe implementation of “handshake stewardship” at Children's Hospital Colorado (CHCO), which involves post-prescriptive review of all antimicrobials (without expansive restrictions) coupled with rounding based, face-to-face discussions with providers.
We performed a quasi-experimental study evaluating the trends of antimicrobial use during pre-implementation, planning, and post-implementation phases of our ASP. All antimicrobial orders (antibiotic, antifungal and antiviral) administered on the inpatient services of the main hospital at CHCO between October 2010 and September 2014 are included. Antimicrobial use is described in DOT/1000 PD. For the three time periods, one way ANOVA and segmented regression are used for analysis. Comparisons are made between time periods for antimicrobials overall, by antibiotics, antifungals, and antivirals, by specific antibiotic, and by unit.
Mean overall antimicrobial use decreased by 11% from pre-implementation to post-implementation (942 to 839 DOT/1000 PD, p<0.01). Mean use of antibiotics decreased from 750 to 673 DOT/1000 PD (11%, p<0.01), antifungals from 124 to 108 DOT/1000 PD (13%, p<0.06), and antivirals from 67 to 56 DOT/1000 PD (17%, p=0.01). The largest reductions were observed in vancomycin and meropenem, without concomitant increase in similar spectra agents. With the exception of pulmonary, overall use decreased on all units by 9-19%.
Implementation of “handshake stewardship,” a rounding-based antimicrobial optimization service, is highly effective, and drives down use to 673 DOT/1000 PD, 100 DOT/1000 PD less than published reports. The impact is hospital wide, across all classes of agents, and in nearly every unit. Additional unexpected benefits of “handshake stewardship” are noted in terms of inter-hospital relations, and a general culture of resource stewardship.
J. Child, None
C. Palmer, None
K. Pearce, None