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Updated: Feb 4, 2026
Antimicrobial Characterization of Advanced Materials for Bioengineering Applications
Published on: August 4, 2018
Factors associated with adherence to antimicrobial stewardship after-hours
Mona Mostaghim1,2, Thomas Snelling3,4,5, Beata Bajorek1
1Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
Objectives:
Assess restricted antimicrobials acquired after standard working hours for adherence to antimicrobial stewardship (AMS) and identify factors associated with increased likelihood of adherence at the time of acquisition, and the next standard working day.
Methods:
All documented antimicrobials acquired from a paediatric hospital after-hours drug room from 1 July 2014 to 30 June 2015 were reconciled with records of AMS approval, and documented AMS review in the medical record.
Key Findings:
Of the 758 antimicrobial acquisitions from the after-hours drug room, 62.3% were restricted. Only 29% were AMS adherent at the time of acquisition, 15% took place despite documented request for approval by a pharmacist. Antimicrobials for respiratory patients (OR 3.10, 95% CI 1.68-5.5) and antifungals (2.48, 95% CI 1.43-4.30) were more likely to be AMS adherent. Half of the acquisitions that required review the next standard working day were adherent to AMS (51.8%, 129/249). Weekday acquisitions (2.10, 95% CI 1.20-3.69) and those for patients in paediatric intensive care (2.26, 95% CI 1.07-4.79) were associated with AMS adherence. Interactions with pharmacists prior to acquisition did not change the likelihood of AMS adherence the next standard working day. Access to restricted antimicrobial held as routine ward stock did not change the likelihood of AMS adherence at the time of acquisition, or the next standard working day.
Conclusion:
Restricted antimicrobials acquired after-hours are not routinely AMS adherent at the time of acquisition or the next standard working day, limiting opportunities for AMS involvement.
Insights
Restricted antimicrobials acquired after hours show low adherence to antimicrobial stewardship (AMS). Interventions are needed to improve AMS involvement and ensure appropriate use of these critical medications.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Antimicrobial Stewardship
Background:
- Antimicrobial resistance is a significant global health threat.
- Effective antimicrobial stewardship (AMS) programs are crucial for optimizing antimicrobial use and combating resistance.
- After-hours medication acquisition in hospitals presents unique challenges for AMS oversight.
Purpose of the Study:
- To evaluate adherence to antimicrobial stewardship (AMS) for restricted antimicrobials obtained outside standard working hours.
- To identify factors influencing AMS adherence at the time of acquisition and on the subsequent working day.
Main Methods:
- A retrospective review of all antimicrobial acquisitions from a pediatric hospital's after-hours drug room over a one-year period.
- Reconciliation of acquisitions with AMS approval records and documented medical record reviews.
Main Results:
- 62.3% of after-hours acquisitions were restricted antimicrobials.
- Only 29% of these acquisitions were AMS adherent at acquisition; 15% proceeded despite pharmacist requests for approval.
- Adherence was higher for respiratory patients and antifungals. Weekday acquisitions and those in pediatric intensive care showed better adherence.
- Half of acquisitions requiring next-day review were adherent; pharmacist interaction did not improve adherence.
Conclusions:
- Restricted antimicrobials acquired after hours demonstrate suboptimal AMS adherence.
- Opportunities for AMS intervention are limited due to delayed or absent adherence.
- Strategies to enhance after-hours AMS oversight are necessary.
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