Capturing outcomes of targeted antibiotic stewardship (AS) education to clinical pharmacists (CPs) though the creation of a customized electronic documentation form

Background: Education is a core element used in AS programs (ASPs).  Few examples exist in the literature on how to capture outcomes of targeted AS education strategies.

Methods:  The infectious diseases (ID) pharmacist began targeted education with CPs at a 359 bed community teaching hospital in 2011 including didactic lectures, competency exams and individual case help on topics such as ID guidelines, shortening durations, de-escalation, pharmacokinetic/ pharmacodynamic (PK/PD) dosing and procalcitonin testing. In addition, a vancomycin monitoring service conducted by all pharmacists on all shifts was implemented in 2013 after completing extensive PK education.  Prior to 2015, CPs used a general Cerner® pharmacy intervention form to document recommendations made to providers.  In 2015 a new form was customized with options for documenting interventions specific to AS activities targeted through education (Figure 1); a new Cerner® report was written to capture the data.  CP antibiotic-related interventions (ARIs) from the 2010 year were compared to the 2015 year to determine if education increased the number and quality of ARIs.

Results:  The number of ARIs increased by 55% from 2,511 pre-education (3% not accepted by providers) to 3,900 post-education (1% not accepted).  Lower level ARIs (optimize monitoring, IV to PO, order/allergy clarification, lab recommendations and other) decreased from 1,061 in 2010 to 407 in 2015.  Higher-level ARIs increased from 2010 to 2015.  PK/PD and renal dose adjustments increased by 5.4-fold from 374 to 2,011, and ARIs involving discontinuation/shortening durations increased by 77% from 356 to 631, respectively.  Initial antibiotic selection, escalation and de-escalation were previously captured under a “therapeutic recommendations” category and increased by 65% from 388 (2010) to 639 (2015) ARIs.

Conclusion: A customized ASP intervention form for electronic documentation of CP ASP activities can capture outcomes of targeted education strategies and serve as a quality control mechanism for ARIs.  The increase in number, acceptance and quality of ARIs demonstrates that clinical pharmacists can play a vital role in furthering the reach of ASP interventions with directed education from ID specialists.