Evaluation of pharmacy generalists performing antimicrobial stewardship services.
Carreno JJ, Kenney RM, Bloome M, McDonnell J, Rodriguez J, Weinmann A, Kilgore PE, and Davis SL. Evaluation of pharmacy generalists performing antimicrobial stewardship services. Am J Health Syst Pharm 2015; 72(15):1298-1303.
American Journal of Health-System Pharmacy
PURPOSE: Improvements in medication use achieved by pharmacy generalists using a care bundle approach to antimicrobial stewardship are reported.
METHODS: A six-month prospective, repeated-treatment, quasi-experimental study involving three month-long intervention periods and three month-long control periods was conducted in the setting of an existing antimicrobial stewardship program at a large hospital. The intervention involved prospective audit and feedback conducted by pharmacy generalists who were trained in an antimicrobial stewardship care bundle approach. During control months, a pharmacy generalist who was not trained in antimicrobial stewardship rounded with the multidisciplinary team and provided standard-of-care pharmacy services. The primary endpoint was compliance with a care bundle of four antimicrobial stewardship metrics: documentation of indication for therapy in the medical record, selection of empirical therapy according to institutional guidelines, documented performance of indicated culture testing, and deescalation of therapy when indicated.
RESULTS: Two-hundred eighty-six patients were enrolled in the study: 124 in the intervention group and 162 in the control group. The cumulative rate of full compliance with all care bundle components during the six-month study was significantly greater during intervention months than during control months (68.5% versus 45.7%, p < 0.001). After adjusting for infection type, antimicrobial stewardship provided by an intervention-group pharmacist was associated with improved care bundle compliance (adjusted odds ratio, 2.70; p < 0.001). No significant differences in patient outcomes during intervention and control months were detected.
CONCLUSION: Pharmacy generalists trained to comply with a systematic care bundle approach enhanced the quality of antimicrobial management.
Medical Subject Headings
Aged; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Female; Humans; Male; Middle Aged; Pharmacy Service, Hospital; Professional Role; Prospective Studies; Quality Assurance, Health Care; United States