A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)

A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)

Abstract Background ASPs continue to investigate novel ways to improve appropriate antibiotic utilization. The impact of an ASP-led, multi-faceted coaching and real-time feedback model directed towards clinical pharmacists was evaluated. Methods A single-center, pre-post quasi-experimental study was...

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Veröffentlicht in:Open forum infectious diseases 2017-10, Vol.4 (suppl_1), p.S482-S482
Hauptverfasser: Boyd, Anthony M, Nagel, Jerod, Eschenauer, Gregory, Marshall, Vincent D, Gandhi, Tejal, Chenoweth, Carol, Petty, Lindsay, McClung, Daniel, Patel, Twisha S
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container_end_page S482
container_issue suppl_1
container_start_page S482
container_title Open forum infectious diseases
container_volume 4
creator Boyd, Anthony M
Nagel, Jerod
Eschenauer, Gregory
Marshall, Vincent D
Gandhi, Tejal
Chenoweth, Carol
Petty, Lindsay
McClung, Daniel
Patel, Twisha S
description Abstract Background ASPs continue to investigate novel ways to improve appropriate antibiotic utilization. The impact of an ASP-led, multi-faceted coaching and real-time feedback model directed towards clinical pharmacists was evaluated. Methods A single-center, pre-post quasi-experimental study was conducted with a four-month historical control period (11/2016–2/2017) and four-month intervention period (4/2016–7/2016) to reduce the use of ceftriaxone, fluoroquinolones, and clindamycin. Clinical pharmacists were responsible for ensuring the appropriate use of these restricted antimicrobials with limited guidance by the ASP in the historical control period. The intervention was multi-faceted: ASP pharmacists provided daily coaching and feedback on use of targeted agents to the clinical pharmacists, clinical pharmacists made recommendations to optimize therapy, and in-person monthly sessions were held where a dashboard consisting of aggregated utilization data and HA-CDI rates was discussed by the ASP pharmacist. Segmented regression analysis was used to determine the significance of this intervention on the utilization of the antibiotics, measured by days of therapy (DOT) per 1000 patient-days (PD). Rates of HA-CDI were also compared between the groups. Results The use of fluoroquinolones (34.4 vs. 26.2 DOT/1000 PD; Δ -23.9%), ceftriaxone (17.7 vs.. 13.6 DOT/1000 PD; ∆ -23.2%), and clindamycin (18.7 vs.. 13.3 DOT/1000 PD; ∆ -28.9%) decreased during the intervention period. Using segmented regression analysis, a significant decreasing rate of antibiotic use of all three agents was observed during the intervention period (Table). A significant decreasing rate of HA-CDI was also seen (rate ratio (RR): 0.787, 95% CI: 0.743–0.833, P < 0.001). Conclusion A multi-faceted coaching and feedback intervention targeting clinical pharmacists with substantial ASP oversight can significantly reduce inappropriate antibiotic use and HA-CDI in a large hospital. Table Segmented Regression Analysis Drug Effect Rate Ratio 95% CI P-value Fluoroquinolones Intervention*time 0.971 0.949–0.995 0.016 Ceftriaxone Intervention*time 0.842 0.795–0.891
doi_str_mv 10.1093/ofid/ofx163.1239
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The impact of an ASP-led, multi-faceted coaching and real-time feedback model directed towards clinical pharmacists was evaluated. Methods A single-center, pre-post quasi-experimental study was conducted with a four-month historical control period (11/2016–2/2017) and four-month intervention period (4/2016–7/2016) to reduce the use of ceftriaxone, fluoroquinolones, and clindamycin. Clinical pharmacists were responsible for ensuring the appropriate use of these restricted antimicrobials with limited guidance by the ASP in the historical control period. The intervention was multi-faceted: ASP pharmacists provided daily coaching and feedback on use of targeted agents to the clinical pharmacists, clinical pharmacists made recommendations to optimize therapy, and in-person monthly sessions were held where a dashboard consisting of aggregated utilization data and HA-CDI rates was discussed by the ASP pharmacist. Segmented regression analysis was used to determine the significance of this intervention on the utilization of the antibiotics, measured by days of therapy (DOT) per 1000 patient-days (PD). Rates of HA-CDI were also compared between the groups. Results The use of fluoroquinolones (34.4 vs. 26.2 DOT/1000 PD; Δ -23.9%), ceftriaxone (17.7 vs.. 13.6 DOT/1000 PD; ∆ -23.2%), and clindamycin (18.7 vs.. 13.3 DOT/1000 PD; ∆ -28.9%) decreased during the intervention period. Using segmented regression analysis, a significant decreasing rate of antibiotic use of all three agents was observed during the intervention period (Table). A significant decreasing rate of HA-CDI was also seen (rate ratio (RR): 0.787, 95% CI: 0.743–0.833, P &lt; 0.001). Conclusion A multi-faceted coaching and feedback intervention targeting clinical pharmacists with substantial ASP oversight can significantly reduce inappropriate antibiotic use and HA-CDI in a large hospital. Table Segmented Regression Analysis Drug Effect Rate Ratio 95% CI P-value Fluoroquinolones Intervention*time 0.971 0.949–0.995 0.016 Ceftriaxone Intervention*time 0.842 0.795–0.891 &lt;0.001 Clindamycin Intervention*time 0.931 0.904–0.958 &lt;0.001 Disclosures G. Eschenauer, Merck: Grant Investigator, Research grant; V. D. Marshall, Merck: Grant Investigator, Research grant</description><identifier>ISSN: 2328-8957</identifier><identifier>EISSN: 2328-8957</identifier><identifier>DOI: 10.1093/ofid/ofx163.1239</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Abstracts</subject><ispartof>Open forum infectious diseases, 2017-10, Vol.4 (suppl_1), p.S482-S482</ispartof><rights>The Author 2017. 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The impact of an ASP-led, multi-faceted coaching and real-time feedback model directed towards clinical pharmacists was evaluated. Methods A single-center, pre-post quasi-experimental study was conducted with a four-month historical control period (11/2016–2/2017) and four-month intervention period (4/2016–7/2016) to reduce the use of ceftriaxone, fluoroquinolones, and clindamycin. Clinical pharmacists were responsible for ensuring the appropriate use of these restricted antimicrobials with limited guidance by the ASP in the historical control period. The intervention was multi-faceted: ASP pharmacists provided daily coaching and feedback on use of targeted agents to the clinical pharmacists, clinical pharmacists made recommendations to optimize therapy, and in-person monthly sessions were held where a dashboard consisting of aggregated utilization data and HA-CDI rates was discussed by the ASP pharmacist. Segmented regression analysis was used to determine the significance of this intervention on the utilization of the antibiotics, measured by days of therapy (DOT) per 1000 patient-days (PD). Rates of HA-CDI were also compared between the groups. Results The use of fluoroquinolones (34.4 vs. 26.2 DOT/1000 PD; Δ -23.9%), ceftriaxone (17.7 vs.. 13.6 DOT/1000 PD; ∆ -23.2%), and clindamycin (18.7 vs.. 13.3 DOT/1000 PD; ∆ -28.9%) decreased during the intervention period. Using segmented regression analysis, a significant decreasing rate of antibiotic use of all three agents was observed during the intervention period (Table). A significant decreasing rate of HA-CDI was also seen (rate ratio (RR): 0.787, 95% CI: 0.743–0.833, P &lt; 0.001). Conclusion A multi-faceted coaching and feedback intervention targeting clinical pharmacists with substantial ASP oversight can significantly reduce inappropriate antibiotic use and HA-CDI in a large hospital. Table Segmented Regression Analysis Drug Effect Rate Ratio 95% CI P-value Fluoroquinolones Intervention*time 0.971 0.949–0.995 0.016 Ceftriaxone Intervention*time 0.842 0.795–0.891 &lt;0.001 Clindamycin Intervention*time 0.931 0.904–0.958 &lt;0.001 Disclosures G. Eschenauer, Merck: Grant Investigator, Research grant; V. D. 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The impact of an ASP-led, multi-faceted coaching and real-time feedback model directed towards clinical pharmacists was evaluated. Methods A single-center, pre-post quasi-experimental study was conducted with a four-month historical control period (11/2016–2/2017) and four-month intervention period (4/2016–7/2016) to reduce the use of ceftriaxone, fluoroquinolones, and clindamycin. Clinical pharmacists were responsible for ensuring the appropriate use of these restricted antimicrobials with limited guidance by the ASP in the historical control period. The intervention was multi-faceted: ASP pharmacists provided daily coaching and feedback on use of targeted agents to the clinical pharmacists, clinical pharmacists made recommendations to optimize therapy, and in-person monthly sessions were held where a dashboard consisting of aggregated utilization data and HA-CDI rates was discussed by the ASP pharmacist. Segmented regression analysis was used to determine the significance of this intervention on the utilization of the antibiotics, measured by days of therapy (DOT) per 1000 patient-days (PD). Rates of HA-CDI were also compared between the groups. Results The use of fluoroquinolones (34.4 vs. 26.2 DOT/1000 PD; Δ -23.9%), ceftriaxone (17.7 vs.. 13.6 DOT/1000 PD; ∆ -23.2%), and clindamycin (18.7 vs.. 13.3 DOT/1000 PD; ∆ -28.9%) decreased during the intervention period. Using segmented regression analysis, a significant decreasing rate of antibiotic use of all three agents was observed during the intervention period (Table). A significant decreasing rate of HA-CDI was also seen (rate ratio (RR): 0.787, 95% CI: 0.743–0.833, P &lt; 0.001). Conclusion A multi-faceted coaching and feedback intervention targeting clinical pharmacists with substantial ASP oversight can significantly reduce inappropriate antibiotic use and HA-CDI in a large hospital. Table Segmented Regression Analysis Drug Effect Rate Ratio 95% CI P-value Fluoroquinolones Intervention*time 0.971 0.949–0.995 0.016 Ceftriaxone Intervention*time 0.842 0.795–0.891 &lt;0.001 Clindamycin Intervention*time 0.931 0.904–0.958 &lt;0.001 Disclosures G. Eschenauer, Merck: Grant Investigator, Research grant; V. D. Marshall, Merck: Grant Investigator, Research grant</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/ofid/ofx163.1239</doi><oa>free_for_read</oa></addata></record>
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title A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)
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