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Outcomes of an electronic medical record (EMR)–driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the “Five Moments of Antimicrobial Prescribing”

Published online by Cambridge University Press:  13 August 2019

Misha Devchand*
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
Andrew J. Stewardson
Affiliation:
Department of Infectious Diseases, The Alfred Hospital, VIC, Australia Central Clinical School, Monash University, Australia
Karen F. Urbancic
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Pharmacy Department, Austin Health, Heidelberg, VIC, Australia The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, VIC, Australia
Sharmila Khumra
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
Andrew A. Mahony
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
Steven Walker
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
Kent Garrett
Affiliation:
Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
M. Lindsay Grayson
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Medicine (Austin Health), University of Melbourne, Parkville, VIC, Australia
Jason A. Trubiano
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, VIC, Australia Department of Medicine (Austin Health), University of Melbourne, Parkville, VIC, Australia
*
Author for correspondence: Misha Devchand, Department of Infectious Diseases, Austin Health, PO Box 5555, Heidelberg VIC Australia. E-mail: [email protected]

Abstract

Objective:

The primary objective of this study was to examine the impact of an electronic medical record (EMR)–driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed “5 Moments of Antimicrobial Prescribing” metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.

Methods:

A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS recommendation was made. The impact of the ICU-AMS round on antimicrobial appropriateness was evaluated using point-prevalence survey data.

Results:

For the 202 patients, 412 recommendations were made in accordance with the “5 Moments” metric. The most common recommendation made by the ICU-AMS team was moment 3 (discontinuation), which comprised 173 of 412 recommendations (42.0%), with an acceptance rate of 83.8% (145 of 173). Data collected for point-prevalence surveys showed an increase in prescribing appropriateness from 21 of 45 (46.7%) preintervention (October 2016) to 30 of 39 (76.9%) during the study period (September 2017).

Conclusions:

The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our “5 Moments of Antimicrobial Prescribing” metric provides a framework for measuring AMS recommendation compliance.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Vincent, J, Rello, J, Marshall, J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:23232329.CrossRefGoogle Scholar
Luyt, CE, Bréchot, N, Trouillet, JL, et al. Antibiotic stewardship in the intensive care unit. Crit Care 2014;18:480.CrossRefGoogle ScholarPubMed
Katsios, CM, Burry, L, Nelson, S, et al. An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients. Crit Care 2012;16:R216.CrossRefGoogle ScholarPubMed
Adhikari, S, Piza, M, Taylor, P, et al. Sustained multimodal antimicrobial stewardship in an Australian tertiary intensive care unit from 2008–2015: an interrupted time-series analysis. Int J Antimicrob Agents 2018;51:620628.CrossRefGoogle Scholar
Cairns, KA, Bortz, HD, Le, A, et al. ICU antimicrobial stewardship (AMS) rounds: the daily activities of an AMS service. Int J Antimicrob Agents 2016;48:575576.CrossRefGoogle ScholarPubMed
Cairns, KA, Jenney, AW, Abbott, IJ, et al. Prescribing trends before and after implementation of an antimicrobial stewardship program. Med J Aust 2013;198:262626.CrossRefGoogle ScholarPubMed
Alvarez-Lerma, F, Grau, S, Echeverria-Esnal, D, et al. A before-and-after study of the effectiveness of an antimicrobial stewardship program in critical care. Antimicrob Agents Chemother 2018;62(4):pii–e0182517.CrossRefGoogle ScholarPubMed
Khdour, MR, Hallak, HO, Aldeyab, MA, et al. Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study. Br J Clin Pharmacol 2018;84:708715.CrossRefGoogle Scholar
Pogue, JM, Potoski, BA, Postelnick, M, et al. Bringing the “power” to Cerner’s PowerChart for antimicrobial stewardship. Clin Infect Dis 2014;59:416424.CrossRefGoogle ScholarPubMed
Micallef, C, Chaudhry, NT, Holmes, AH, et al. Secondary use of data from hospital electronic prescribing and pharmacy systems to support the quality and safety of antimicrobial use: a systematic review. J Antimicrob Chemother 2017;72:18801885.CrossRefGoogle ScholarPubMed
James, R, Upjohn, L, Cotta, M, et al. Measuring antimicrobial prescribing quality in Australian hospitals: development and evaluation of a national antimicrobial prescribing survey tool. J Antimicrob Chemother 2015;70:19121918.Google ScholarPubMed
Spivak, ES, Cosgrove, SE, Srinivasan, A. Measuring appropriate antimicrobial use: attempts at opening the black box. Clin Infect Dis 2016;63:16391644.Google ScholarPubMed
Dresser, LD, Bell, CM, Steinberg, M, et al. Use of a structured panel process to define antimicrobial prescribing appropriateness in critical care. J Antimicrob Chemother 2018;73:246249.CrossRefGoogle ScholarPubMed
Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.CrossRefGoogle Scholar
James, RS, McIntosh, KA, Luu, SB, et al. Antimicrobial stewardship in Victorian hospitals: a statewide survey to identify current gaps. Med J Aust 2013;199:692695.CrossRefGoogle ScholarPubMed
DiazGranados, CA. Prospective audit for antimicrobial stewardship in intensive care: impact on resistance and clinical outcomes. Am J Infect Control 2012;40:526529.CrossRefGoogle ScholarPubMed
Elligsen, M, Walker, SA, Pinto, R, et al. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infect Control Hosp Epidemiol 2012;33:354361.CrossRefGoogle ScholarPubMed
Weiss, CH, Dibardino, D, Rho, J, et al. A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization. Crit Care Med 2013;41:25632569.CrossRefGoogle ScholarPubMed
Cresswell, K, Mozaffar, H, Shah, S, et al. Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review. Int J Pharm Pract 2017;25:517.CrossRefGoogle ScholarPubMed
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51e77.CrossRefGoogle Scholar
Morris, AM. Antimicrobial stewardship programs: appropriate measures and metrics to study their impact. Curr Treat Options Infect Dis 2014;6:101112.CrossRefGoogle ScholarPubMed
Broom, J, Broom, A, Plage, S, et al. Barriers to uptake of antimicrobial advice in a UK hospital: a qualitative study. J Hosp Infect 2016;93:418422.CrossRefGoogle Scholar
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