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Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy, the infectious disease
J J Schentag1, C H Ballow, A L Fritz
1Center for Clinical Pharmacy Research, State University of New York (SUNY), Buffalo.
Abstract:
Rapid reporting of culture and susceptibility data is the first of several important steps in the successful management of infected patients. As has been said many times, rapidly reported data are of little value unless the patient directly benefits. Benefit requires better overall communication and an action plan linked to timely use of these results. In 1989 the Millard Fillmore Hospital Antibiotic Review Committee developed and implemented a prototype approach to hospital wide antimicrobial management. The formulary was revised and the drug use evaluation process modified to enhance effectiveness and to lower the cost of therapy and inventory. Clinical pharmacy antimicrobial agent management specialists were then recruited to individualize patient treatments to the isolated pathogens in conjunction with the Division of Infectious Diseases. To provide the clinical pharmacy specialists with rapid and clinically useful information, a real-time computer link was created between the pharmacy (antibiotic orders) and the microbiology laboratory (culture results). Customized software was implemented to screen all patients automatically for mismatches between pathogens and drugs, or to screen for doses inappropriate to minimum inhibitory concentration or renal function. Special attention was paid to identification of opportunities to target a more appropriate narrow-spectrum regimen after culture results became available. Changes in antimicrobial regimen or dosage were made by contacting the prescribing physician. Over 90% of the recommended changes were made, and virtually all changed regimens had satisfactory clinical outcome. Real dollar expenditures for antimicrobial agents declined by > $200,000 per year. Prior to the institution of this computerized clinical management strategy, antimicrobial purchases were rising yearly at the rate of 12%-15%. The combined efforts of clinical pharmacy, microbiology, and infectious disease personnel successfully optimized antimicrobial therapy on a hospital wide basis. Antimicrobial agent optimization improved patient outcome, and the cost savings more than covered the costs of the program personnel and software.
Insights
Implementing a hospital-wide antimicrobial management program, including real-time data links and clinical pharmacy specialists, significantly improved patient outcomes and reduced antimicrobial costs. This strategy optimized therapy and demonstrated cost savings.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Medical Informatics
Background:
- Effective management of infected patients relies on rapid reporting of culture and susceptibility data.
- Timely use of microbiological data is crucial for patient benefit, requiring improved communication and action plans.
- Hospital antimicrobial expenditures were rising annually prior to this intervention.
Purpose of the Study:
- To develop and implement a hospital-wide antimicrobial management program.
- To integrate clinical pharmacy specialists and real-time data for individualized patient treatment.
- To optimize antimicrobial therapy, improve patient outcomes, and reduce healthcare costs.
Main Methods:
- Revised formulary and modified drug use evaluation processes.
- Recruited clinical pharmacy antimicrobial agent management specialists.
- Established a real-time computer link between pharmacy and microbiology laboratory.
- Implemented customized software for automated screening of antimicrobial regimens.
- Facilitated communication between specialists and physicians for regimen adjustments.
Main Results:
- Over 90% of recommended antimicrobial regimen changes were adopted by physicians.
- Virtually all modified regimens resulted in satisfactory clinical outcomes.
- Annual expenditures for antimicrobial agents decreased by over $200,000.
- Achieved a significant reduction in the previous 12%-15% annual rise in antimicrobial purchases.
Conclusions:
- A computerized clinical management strategy, involving interdisciplinary collaboration, successfully optimized hospital-wide antimicrobial therapy.
- The program improved patient outcomes and generated cost savings that exceeded program expenses.
- This integrated approach demonstrates the value of real-time data and clinical pharmacy involvement in antimicrobial stewardship.