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Implementation and Impact of an Antimicrobial Stewardship Program at a Non-freestanding Children's Hospital
Insights
Implementing an Antimicrobial Stewardship Program (ASP) in a non-freestanding children's hospital reduced antibiotic use. This pediatric ASP demonstrated feasibility and modest antibiotic reduction without negatively impacting patient outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Health Services Research
- Clinical Pharmacy
Background:
- Antimicrobial Stewardship Programs (ASP) improve antibiotic use and patient outcomes.
- Studies on ASPs in non-freestanding children's hospitals are limited.
- This study focuses on a multidisciplinary ASP at a non-freestanding children's hospital.
Purpose of the Study:
- To present the implementation of a collaborative physician and pharmacist-driven ASP.
- To evaluate the impact of the ASP on antibiotic utilization and patient outcomes.
- To assess the feasibility of ASP in a non-freestanding pediatric setting.
Main Methods:
- Descriptive design for implementation assessment.
- Interrupted time series design for impact analysis (pre: Aug 2013-Jul 2014, post: Dec 2014-May 2016).
- Evaluated antibiotic reviews, recommendations, acceptance rates, days of therapy (DOT/1000 PD), and 30-day readmissions.
Main Results:
- 882 reviews conducted on 637 patients, generating 327 recommendations.
- Reviews for vancomycin, clindamycin, and intensivist/hospitalist care prompted most recommendations.
- Mean targeted antibiotic usage decreased by 24.8 DOT/1000 PD; 30-day readmissions remained unchanged.
Conclusions:
- ASP implementation in a non-freestanding children's hospital is feasible.
- The ASP identified areas for quality improvement.
- Modest antibiotic use reduction was achieved without adverse patient impact.
Objectives:
Pediatric Antimicrobial Stewardship Programs (ASP) have been associated with improvements in antibiotic utilization and patient outcomes; however, ASP studies originating from non-freestanding children's hospitals are lacking. In this study, we present the implementation and impact of a multidisciplinary ASP that employs a collaborative physician and pharmacist driven thrice-weekly prospective audit-with-feedback approach at a non-freestanding children's hospital.
Methods:
Implementation was assessed via descriptive design. Pediatric inpatients maintained on predefined targeted antibiotics of interest for 48 to 72 hours preceding ASP review were eligible for inclusion. Outcomes evaluated included ASP recommendation and provider acceptance rates (overall and by antibiotic and provider specialty). Impact was examined using an interrupted time series design (with a preimplementation period of August 1, 2013, to July 31, 2014 and postimplementation period of December 1, 2014 to May 31, 2016). Eligibility included all targeted antibiotic usage among pediatric inpatients, with a control group comprising those who received antibiotics requiring preauthorization. Outcomes analyzed included days of antibiotic therapy per 1000 patient days (DOT/1000 PD) and 30-day hospital readmission rates over time.
Results:
Postimplementation, 882 antibiotic reviews were performed on 637 patients, with 327 recommendations generated. Reviews of patients maintained on vancomycin and clindamycin, and of those under care of intensivist and hospitalist physicians, were most likely to prompt recommendations. A mean targeted antibiotic usage decrease of 24.8 DOT/1000 PD (95% confidence interval, -62 to 14) was observed postimplementation, with no change in 30-day readmissions (0.64% during both periods).
Conclusions:
ASP implementation at a non-freestanding children's hospital was feasible and allowed for identification of areas for targeted quality improvement, while demonstrating modest antibiotic use reduction without adversely impacting patient care.