Enforcing a policy for restricting antimicrobial drug use

Area of Science:

• Infectious Diseases
• Hospital Pharmacy
• Health Economics

Background:

• A large county teaching hospital had an unenforced policy restricting eight intravenous antimicrobial agents for two years.
• An organized enforcement effort began in 1994 to promote effective and economical antimicrobial prescribing.

Purpose of the Study:

• To describe the experience of enforcing an antimicrobial restriction policy.
• To evaluate the impact of policy enforcement on antimicrobial use and costs.

Main Methods:

• Implemented a policy requiring infectious disease physician approval for restricted antimicrobial dispensing.
• Utilized a dedicated team of pharmacists to guide prescribing practices.
• Monitored antimicrobial usage and acquisition costs over a nine-month enforcement period.

Main Results:

• Use of restricted antimicrobials declined, while nonrestricted agents increased.
• Acquisition costs for restricted drugs decreased by over $82,000 within two months.
• Physician compliance was generally high, with some resistance from surgical residents.

Conclusions:

• Enforcement of antimicrobial restriction policies can decrease drug use and achieve significant cost avoidance.
• Policy modifications and targeted education are necessary to address emerging usage patterns and prescribing resistance.
• Multidisciplinary collaboration, including pharmacists and infectious disease specialists, is crucial for successful policy implementation.