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American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists


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

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