Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital

Donald F. Storey, Perry G. Pate, Autumn T.T. Nguyen, Fung Chang

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback.Methods: For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology) and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents.Results: The antimicrobial stewardship team (AST) made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 - December 2010). Physicians implemented recommendation(s) from each of 234 (75%) audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 - August 2009), there was a 22% decrease in defined daily doses per 100 admissions (P = .006) and a 16% reduction per 1000 patient-days (P = .013). There was a 32% reduction in antimicrobial acquisition cost per admission (P = .013) and a 25% acquisition cost reduction per patient-day (P = .022).Conclusions: An effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital.

Original languageEnglish (US)
Article number32
JournalAntimicrobial Resistance and Infection Control
Volume1
DOIs
StatePublished - Oct 9 2012
Externally publishedYes

Fingerprint

Community Hospital
Costs and Cost Analysis
Physicians
Dichlorodiphenyldichloroethane
Clostridium difficile
Patient Admission
Anti-Infective Agents
Pharmacists
Medical Records
Communicable Diseases
Inpatients
Therapeutics
Pharmaceutical Preparations

Keywords

  • Antimicrobial stewardship
  • ASP
  • Small community hospital

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital. / Storey, Donald F.; Pate, Perry G.; Nguyen, Autumn T.T.; Chang, Fung.

In: Antimicrobial Resistance and Infection Control, Vol. 1, 32, 09.10.2012.

Research output: Contribution to journalArticle

@article{a7290ef6e4ac4299b5aff1d2a1a26d0a,
title = "Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital",
abstract = "Background: Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback.Methods: For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology) and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents.Results: The antimicrobial stewardship team (AST) made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 - December 2010). Physicians implemented recommendation(s) from each of 234 (75{\%}) audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 - August 2009), there was a 22{\%} decrease in defined daily doses per 100 admissions (P = .006) and a 16{\%} reduction per 1000 patient-days (P = .013). There was a 32{\%} reduction in antimicrobial acquisition cost per admission (P = .013) and a 25{\%} acquisition cost reduction per patient-day (P = .022).Conclusions: An effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital.",
keywords = "Antimicrobial stewardship, ASP, Small community hospital",
author = "Storey, {Donald F.} and Pate, {Perry G.} and Nguyen, {Autumn T.T.} and Fung Chang",
year = "2012",
month = "10",
day = "9",
doi = "10.1186/2047-2994-1-32",
language = "English (US)",
volume = "1",
journal = "Antimicrobial Resistance and Infection Control",
issn = "2047-2994",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital

AU - Storey, Donald F.

AU - Pate, Perry G.

AU - Nguyen, Autumn T.T.

AU - Chang, Fung

PY - 2012/10/9

Y1 - 2012/10/9

N2 - Background: Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback.Methods: For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology) and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents.Results: The antimicrobial stewardship team (AST) made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 - December 2010). Physicians implemented recommendation(s) from each of 234 (75%) audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 - August 2009), there was a 22% decrease in defined daily doses per 100 admissions (P = .006) and a 16% reduction per 1000 patient-days (P = .013). There was a 32% reduction in antimicrobial acquisition cost per admission (P = .013) and a 25% acquisition cost reduction per patient-day (P = .022).Conclusions: An effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital.

AB - Background: Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback.Methods: For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology) and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents.Results: The antimicrobial stewardship team (AST) made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 - December 2010). Physicians implemented recommendation(s) from each of 234 (75%) audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 - August 2009), there was a 22% decrease in defined daily doses per 100 admissions (P = .006) and a 16% reduction per 1000 patient-days (P = .013). There was a 32% reduction in antimicrobial acquisition cost per admission (P = .013) and a 25% acquisition cost reduction per patient-day (P = .022).Conclusions: An effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital.

KW - Antimicrobial stewardship

KW - ASP

KW - Small community hospital

UR - http://www.scopus.com/inward/record.url?scp=84887025030&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887025030&partnerID=8YFLogxK

U2 - 10.1186/2047-2994-1-32

DO - 10.1186/2047-2994-1-32

M3 - Article

C2 - 23043720

AN - SCOPUS:84887025030

VL - 1

JO - Antimicrobial Resistance and Infection Control

JF - Antimicrobial Resistance and Infection Control

SN - 2047-2994

M1 - 32

ER -