Prospective-audit-and-feedback (PAF) is a core strategy to optimize antimicrobial use; however, most antimicrobial stewardship programs (ASPs) only review a restricted set of antimicrobials or certain units. Subsequently, reports of intervention types at pediatric hospitals are skewed to specific antimicrobials and units and only report on a few intervention types. Handshake stewardship at Childrens Hospital Colorado (CHCO) is a new approach involving PAF of all antimicrobials, with communication of interventions provided directly to teams during clinical rounds. Following implementation, we tracked all interventions and describe them by type, antimicrobial, and team. We endeavor to report these results to inform ASPs in identifying 1) types of interventions to track, 2) types of antimicrobials to monitor, and 3) teams to target.
This is a descriptive study of interventions by the CHCO handshake stewardship team which began in October 2013. All interventions made by the ASP were tracked from October 2014 April 2016. Intervention information collected included 1) date, 2) antimicrobial(s) involved, 3) preselected types and subtypes of interventions, 4) team involved, and 5) acceptance.
There were a total of 3,078 interventions with an overall acceptance rate of 86%. De-escalation of therapy was the most common intervention (49%). Vancomycin and anti-pseudomonal β-lactams were most commonly involved in interventions (17% and 15%, respectively). Amoxicillin, ampicillin, and their β-lactamase inhibitor combinations were also commonly involved (13%), as were macrolides and clindamycin (9%) (Figure 1). Interventions were made most commonly on the medical, intensive care, surgical, and oncology units. The acceptance rates amongst teams with over twenty interventions during the study period varied from 68%-100% (Figure 2).
This is the first detailed description of interventions following implementation of handshake stewardship. Antimicrobials not commonly reviewed by ASPs, like amoxicillin, were involved in greater than 10% of interventions, suggesting review of all antimicrobials may be warranted to optimize PAF. ASP interventions result in high acceptance rates among many clinical teams.
A. L. Hurst,
J. Child, None
S. Parker, None