Pharmacist-Led Antibiotic Stewardship Program Reduces Inappropriate Antibiotic Use and Hospital-acquired Clostridium difficile
Jessica Holt, Pharm.D., BCPS-ID, Kristine Gullickson, Pharm.D., Daniel Anderson, M.D., Elliot Francke, MD; Jessica Nerby, M.P.H., Jason Sanchez, M.D.
Abbott Northwestern Hospital, Allina Hospitals & Clinics, Minneapolis, Minnesota
Antibiotic stewardship programs (ASPs) have been shown to improve patient care by reducing inappropriate antimicrobial use, antimicrobial resistance, and hospital-acquired infections. Guidelines recommend a multidisciplinary team that includes an infectious diseases (ID) physician and an ID-trained pharmacist as core members. However, many hospitals struggle to obtain these resources. Although there are several studies describing a multidisciplinary ASP with daily physician involvement, there are limited studies describing a pharmacist-led ASP with no daily physician involvement. The purpose of our study was to determine the impact of a pharmacist-led ASP on inappropriate antibiotic use and costs, compliance with Joint Commission Core Measures, and the incidence of hospital-acquired Clostridium difficile-associated disease (CDAD).
Abbott Northwestern Hospital is a 629 bed community teaching hospital with four independent ID physician practices. Therefore, the team determined that an ID-trained pharmacist would lead the daily operations of the ASP to provide consistency within the program and prevent the perception that the service was driving consults. Prior to implementation, the ID physicians and pharmacist reviewed and revised hospital policies and order sets. Hospital antibiotic usage guidelines were developed in collaboration with the ID physicians, the Infection Control Department, and the Pharmacy & Therapeutics Committee. The purpose of these guidelines was to aid the pharmacist in determining appropriate use of commonly used and broad spectrum antibiotics. The pharmacist-led ASP was implemented hospital-wide in July 2009. The pharmacist reviewed antibiotic orders daily for adult patients who did not have an active ID physician consult. The pharmacist made recommendations based on current published guidelines, hospital usage guidelines, and hospital medication policies. The ID physicians were available for curbside consults if needed, but were not involved in daily operations.
In 2010, the pharmacist made 1419 recommendations with a 90% acceptance rate. The most common recommendations were to discontinue/assess duration of antibiotic therapy (n=650) and to change/modify antibiotic therapy (n=303). The pharmacist-led ASP prevented 61 antibiotic-related Joint Commission Core Measure “misses” as a result of inappropriate surgical prophylaxis or pneumonia antibiotic therapy. Compared to baseline, implementation of the pharmacist-led ASP resulted in a 4.6% decrease in total antibiotic days of therapy (DOT) per 1000 patient days, a 25.5% decrease in total fluoroquinolone DOT per1000 patient days, and a 15.8% decrease in antibiotic cost per patient day, equating to an antibiotic cost savings of approximately $370,000 over the two years. The reduction in total antibiotic and fluoroquinolone usage was a positive contributing factor to the 26% reduction in hospital-acquired CDAD rates in 2010.
A pharmacist-led ASP is innovative in that it does not involve a physician in its daily operations. Our study showed that our pharmacist-led ASP was successful in reducing inappropriate antibiotic use and costs, increasing Joint Commission Core Measure compliance, and reducing hospital-acquired Clostridium difficile-associated disease.
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