Mary T Bessesen1, Andrew Ma2, Daniel Clegg3, Randolph V Fugit4, Anthony Pepe5, Matthew Bidwell Goetz6, Christopher J Graber7. 1. Chief, Infectious Diseases, VA-Eastern Colorado Healthcare System , Denver, Colorado ; Associate Professor, Department of Medicine, University of Colorado Denver. 2. Infectious Diseases Fellow, Cedars-Sinai/UCLA Multicampus Program in Infectious Diseases , Los Angeles, California. 3. Clinical Pharmacy, Moran Eye Center, University of Utah , Salt Lake City, Utah. 4. Internal Medicine Clinical Specialist, VA-Eastern Colorado Healthcare System , Denver, Colorado ; Clinical Associate Professor, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus , Aurora, Colorado. 5. Clinical Pharmacy Program Manager, VA-Eastern Colorado Healthcare System , Denver, Colorado. 6. Chief, Infectious Diseases Section, VA Greater Los Angeles Healthcare System ; Professor of Clinical Medicine, David Geffen School of Medicine at UCLA , Los Angeles, California. 7. Associate Clinical Professor of Medicine, David Geffen School of Medicine at UCLA ; Infectious Diseases Section, VA Greater Los Angeles Healthcare System , Los Angeles, California .
Abstract
BACKGROUND: Stewardship of antimicrobial agents is an essential function of hospital pharmacies. The ideal pharmacist staffing model for antimicrobial stewardship programs is not known. OBJECTIVE: To inform staffing decisions for antimicrobial stewardship teams, we aimed to compare an antimicrobial stewardship program with a dedicated Infectious Diseases (ID) pharmacist (Dedicated ID Pharmacist Hospital) to a program relying on ward pharmacists for stewardship activities (Geographic Model Hospital). METHODS: We reviewed a randomly selected sample of 290 cases of inpatient parenteral antibiotic use. The electronic medical record was reviewed for compliance with indicators of appropriate antimicrobial stewardship. RESULTS: At the hospital staffed by a dedicated ID pharmacist, 96.8% of patients received initial antimicrobial therapy that adhered to local treatment guidelines compared to 87% of patients at the hospital that assigned antimicrobial stewardship duties to ward pharmacists (P < .002). Therapy was modified within 24 hours of availability of laboratory data in 86.7% of cases at the Dedicated ID Pharmacist Hospital versus 72.6% of cases at the Geographic Model Hospital (P < .03). When a patient's illness was determined not to be caused by a bacterial infection, antibiotics were discontinued in 78.0% of cases at the Dedicated ID Pharmacist Hospital and in 33.3% of cases at the Geographic Model Hospital (P < .0002). CONCLUSION: An antimicrobial stewardship program with a dedicated ID pharmacist was associated with greater adherence to recommended antimicrobial therapy practices when compared to a stewardship program that relied on ward pharmacists.
BACKGROUND: Stewardship of antimicrobial agents is an essential function of hospital pharmacies. The ideal pharmacist staffing model for antimicrobial stewardship programs is not known. OBJECTIVE: To inform staffing decisions for antimicrobial stewardship teams, we aimed to compare an antimicrobial stewardship program with a dedicated Infectious Diseases (ID) pharmacist (Dedicated ID Pharmacist Hospital) to a program relying on ward pharmacists for stewardship activities (Geographic Model Hospital). METHODS: We reviewed a randomly selected sample of 290 cases of inpatient parenteral antibiotic use. The electronic medical record was reviewed for compliance with indicators of appropriate antimicrobial stewardship. RESULTS: At the hospital staffed by a dedicated ID pharmacist, 96.8% of patients received initial antimicrobial therapy that adhered to local treatment guidelines compared to 87% of patients at the hospital that assigned antimicrobial stewardship duties to ward pharmacists (P < .002). Therapy was modified within 24 hours of availability of laboratory data in 86.7% of cases at the Dedicated ID Pharmacist Hospital versus 72.6% of cases at the Geographic Model Hospital (P < .03). When a patient's illness was determined not to be caused by a bacterial infection, antibiotics were discontinued in 78.0% of cases at the Dedicated ID Pharmacist Hospital and in 33.3% of cases at the Geographic Model Hospital (P < .0002). CONCLUSION: An antimicrobial stewardship program with a dedicated ID pharmacist was associated with greater adherence to recommended antimicrobial therapy practices when compared to a stewardship program that relied on ward pharmacists.
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