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Impact of Different Methods of Feedback to Clinicians After Postprescription Antimicrobial Review Based on the Centers for Disease Control and Prevention's 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults

Published online by Cambridge University Press:  02 January 2015

Sara E. Cosgrove ,
Alpa Patel ,
Xiaoyan Song ,
Robert E. Miller ,
Kathleen Speck ,
Amy Banowetz ,
Rachel Hadler ,
Ronda L. Sinkowitz-Cochran ,
Denise M. Cardo  and
Arjun Srinivasan
Sara E. Cosgrove*
Affiliation:
Departments of Medicine, Baltimore, Maryland
Alpa Patel
Affiliation:
University of Louisville Health Care—University Hospital, Department of Pharmacy, Louisville, Kentucky
Xiaoyan Song
Affiliation:
Departments of Medicine, Baltimore, Maryland
Robert E. Miller
Affiliation:
Pathology, Baltimore, Maryland
Kathleen Speck
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Amy Banowetz
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Rachel Hadler
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Ronda L. Sinkowitz-Cochran
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Denise M. Cardo
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Arjun Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Osler 425, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287 ([email protected])
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Abstract

Objectives.

To evaluate (1) the framework of the 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults that is part of the Centers for Disease Control and Prevention (CDC) Campaign to Prevent Antimicrobial Resistance in Healthcare Settings, with regard to steps addressing antimicrobial use; and (2) methods of feedback to clinicians regarding antimicrobial use after postprescription review.

Design.

Prospective intervention to identify and modify inappropriate antimicrobial therapy.

Setting.

A 1,000-bed, tertiary care teaching hospital.

Patients.

Inpatients in selected medicine and surgery units receiving broad-spectrum antimicrobials for 48-72 hours.

Interventions.

We created a computer-based clinical-event detection system that automatically identified inpatients taking broad-spectrum and “reserve” antimicrobials for 48-72 hours. Although prior approval was required for initial administration of broad-spectrum and reserve antimicrobials, once approval was obtained, therapy with the antimicrobials could be continued indefinitely at the discretion of the treating clinician. Therapy that was ongoing at 48-72 hours was reviewed by an infectious diseases pharmacist or physician, and when indicated feedback was provided to clinicians to modify or discontinue therapy. Feedback was provided via a direct telephone call, a note on the front of the medical record, or text message sent to the clinician's pager. The acceptance rate of feedback was recorded and recommendations were categorized according to the 12 steps recommended by the CDC.

Results.

Interventions were recommended for 334 (30%) of 1,104 courses of antimicrobial therapy reviewed. A total of 87% of interventions fit into one of the CDC's 12 steps of prevention: 39% into step 3 (“target the pathogen”), 1% into step 4 (“access experts”), 3% into steps 7 and 8 (“treat infection, not colonization or contamination”), 18% into step 9 (“say ‘no’ to vancomycin”), and 26% into step 10 (“stop treatment when no infection”). The rate of compliance with recommendations to improve antimicrobial use was 72%. No differences in compliance were seen with the different methods of feedback.

Conclusions.

Nearly one-third of antimicrobial courses did not follow the CDC's recommended 12 steps for prevention of antimicrobial resistance. Clinicians demonstrated high compliance with following suggestions made after postprescription review, suggesting that it is a useful approach to decreasing and improving antimicrobial use among inpatients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 641 - 646
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Shales, DM, Gerding, DN,, John, JF, et al.. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention Of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275–291.Google Scholar
2.Goldman, DA, Weinstein, RA, Wenzel, RP, et al.. Strategies to prevent and control the emergence and spread of antimicrobial resistant microorganisms in hospitals. JAMA 1996;275:234–240.Google Scholar
3.Schwartz, B, Bell, DM, Hughes, JM. Preventing the emergence of antimicrobial resistance. JAMA 1997;278:944–945.Google Scholar
4.CDC's campaign to prevent antimicrobial resistance in health-care settings. MMWR Morb Mortal Wkly Rep 2002;51:343.Google Scholar
5.Fishman, NO, John, JF. Programmatic role of the infectious disease physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471–485.Google Scholar
6.Barlam, TF, DiVall, M. Antibiotic-stewardship practices at top academic centers throughout the United States and at hospitals throughout Massachusetts. Infect Control Hosp Epidemiol 2006;27:695–703.Google Scholar
7.White, AC, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities and clinical outcomes. Clin Infect Dis 1997;25:230–239.Google Scholar
8.Coleman, RW, Rodondi, LC, Kaubisch, S, Granzella, NB, O'Hanley, PD. Cost-effectiveness of prospective and continuous parenteral antibiotic control: experience at the Palo Alto Veterans Affairs Medical Center. Am J Med 1991;90:439–444.Google Scholar
9.McGowan, JE, Finland, M. Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974;130:165–168.Google Scholar
10.Recco, RA, Gladstone, JL, Friedman, SA, Gerken, EH. Antibiotic control in a municipal hospital. JAMA 1979;241:2283.Google Scholar
11.Paskovaty, A, Pflomm, JM, Myke, N, Seo, SK. A multidisciplinary approach to antimicrobial stewardship: evolution into the 21st century. Int J Antimicrob Agents 2005;25:1–10.Google Scholar
12.Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Morb Mortal Wkly Rep 1995;44(RR-12):1–13.Google Scholar
13.Gross, R, Morgan, AS, Kinky, DE, Weiner, M, Gibson, GA, Fishman, NO. Impact of a hospital based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001;33:289-95.CrossRefGoogle ScholarPubMed
14.Gums, JG, Yancey, RW, Hamilton, CA, Kubilis, PS. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team. Pharmacotherapy 1999;19:1369–1377.Google Scholar
15.Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.Google Scholar
16.Srinivasan, A, Song, X, Richards, A, Sinkowitz-Cochran, R, Cardo, D, Rand, C. A survey of knowledge, attitudes, and beliefs of housestaff physicians from various specialties concerning antimicrobial use and resistance. Arch Intern Med 2004;164:1451–1456.CrossRefGoogle Scholar
17.Giblin, TB, Sinkowitz-Cochran, RL, Harris, PL, et al.; the CDC Campaign to Prevent Antimicrobial Resistance Team. Clinician perceptions of the problem of antimicrobial resistance in healthcare settings. Arch Intern Med 2004;164:1662–1668.Google Scholar
18.Brinsley, KJ, Srinivasan, A, Sinkowitz-Cochran, RL, Lawton, R, Mclntyre, R, Cardo, D. Implementation of the Campaign to prevent antimicrobial resistance in healthcare settings: 12 steps to prevent antimicrobial resistance among hospitalized adults—experiences from three institutions. Am J Infect Control 2005;33:53–54.Google Scholar