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A Quality Assessment of a Collaborative Model of a Pediatric Antimicrobial Stewardship Program
Phuong-Tan Nguyen-Ha1, Denise Howrie1, Kelli Crowley1
1Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
Insights
This study shows an alternative antimicrobial stewardship program (ASP) model using infectious disease (ID) physicians and service-based pharmacists effectively reduced targeted antimicrobial use in a pediatric hospital. Recommendations were highly accepted.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Pediatric Healthcare
Background:
- Infectious Diseases Society of America guidelines recommend dedicated infectious disease (ID) physician leaders and ID-trained clinical pharmacists for antimicrobial stewardship programs (ASPs).
- Limited resources necessitated an alternative ASP model in a pediatric hospital, utilizing ID physicians and service-based clinical pharmacists.
- This study aimed to evaluate the effectiveness and impact of this nontraditional ASP model.
Purpose of the Study:
- To analyze the effectiveness of an alternative antimicrobial stewardship program (ASP) model in a pediatric hospital.
- To assess the impact of integrating infectious disease (ID) physicians with service-based clinical pharmacists within an ASP.
- To determine the impact on the usage of high-use and/or high-cost antimicrobial agents.
Main Methods:
- The alternative ASP model incorporated education, antimicrobial restriction, day 3 audits, and practice guidelines.
- Audits specifically targeted vancomycin, caspofungin, and meropenem, utilizing the electronic medical record for patient identification and recommendation communication.
- Segmented regression analyses were employed to assess quarterly antimicrobial agent prescription data.
Main Results:
- The ASP initiation and day 3 auditing blunted increasing trends for caspofungin and significantly reduced vancomycin use (-25%) and starts (-12%), particularly in critical care.
- Meropenem use declined by 31% (P = .021) despite preauthorization requirements.
- Acceptance rates for ASP recommendations were high, ranging from 90% for vancomycin to 100% for meropenem.
Conclusions:
- The nontraditional ASP model, integrating service-based clinical pharmacists and ID consultants, significantly reduced targeted antimicrobial drug usage.
- This model demonstrates the successful implementation and acceptance of an alternative approach to antimicrobial stewardship in a pediatric setting.
- The findings support the integration of diverse clinical pharmacy services within ASPs to optimize antimicrobial prescribing.
Background:
Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model.
Methods:
The collaborative ASP model incorporated key strategies of education, antimicrobial restriction, day 3 audits, and practice guidelines. High-use and/or high-cost antimicrobial agents were chosen with audits targeting vancomycin, caspofungin, and meropenem. The electronic medical record was used to identify patients requiring day 3 audits and to communicate ASP recommendations. Segmented regression analyses were used to analyze quarterly antimicrobial agent prescription data for the institution and selected services over time.
Results:
Initiation of ASP and day 3 auditing was associated with blunting of a preexisting increasing trend for caspofungin drug starts and use and a significant downward trend for vancomycin drug starts (relative change -12%) and use (-25%), with the largest reduction in critical care areas. Although meropenem use was already low due to preexisting requirements for preauthorization, a decline in drug use (-31%, P = .021) and a nonsignificant decline in drug starts (-21%, P = .067) were noted. A 3-month review of acceptance of ASP recommendations found rates of 90%, 93%, and 100% for vancomycin, caspofungin, and meropenem, respectively.
Conclusions:
This nontraditional ASP model significantly reduced targeted drug usage demonstrating acceptance of integration of service-based clinical pharmacists and ID consultants.
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