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Antimicrobial Stewardship and Automated Pharmacy Technology Improve Antibiotic Appropriateness for Community-Acquired Pneumonia

Published online by Cambridge University Press:  02 January 2015

Belinda Ostrowsky*
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Shweta Sharma
Affiliation:
Montefiore Medical Center, Bronx, New York
Maryrose DeFino
Affiliation:
Montefiore Medical Center, Bronx, New York
Yi Guo
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Purvi Shah
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Susan McAllen
Affiliation:
Montefiore Medical Center, Bronx, New York
Philip Chung
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Shakara Brown
Affiliation:
Montefiore Medical Center, Bronx, New York
Joseph Paternoster
Affiliation:
Montefiore Medical Center, Bronx, New York
Alan Schechter
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Brandon Yongue
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Rohit Bhalla
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
*
Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY 10467 (bostrows@montefiore.org).

Abstract

Background.

The Centers for Medicare and Medicaid Services' (CMS's) Hospital Inpatient Quality Reporting program includes the initial selection of antibiotics for adult community-acquired pneumonia (CAP) patients as a performance measure. A multidisciplinary team denned opportunities for improving performance in appropriate antibiotic use among CAP patients. The team consisted of personnel from the emergency department (ED), the antimicrobial stewardship program (infectious disease, pharmacy), and performance improvement.

Design.

Quasi-experimental before-after study.

Setting.

A large, urban, multicampus academic medical center.

Interventions.

Interventions included an algorithm for ED providers identifying appropriate antibiotic selections, development of a CAP kit consisting of appropriate antibiotics and dosing regimens bundled with the treatment algorithm, and preloading an automated ED medication dispensing and management system. A quality improvement methodology (“plan, do, check, act”) was used to pilot stewardship interventions at one ED campus and later at a second ED campus.

Results.

In the pilot ED, appropriate antibiotic selection for CAP improved from 54.9% before the intervention in 2008 to 93.4% after the intervention in 2011 (P< .001). Subsequently, in the second ED appropriate antibiotic regimens for CAP improved from 64.6% before the intervention in 2008 to 91.3% after the intervention in 2011 (P = .004). The rates of another CMS measure, antibiotic administration within 6 hours, were not statistically different before and after the interventions. In an interrupted time series logistic regression analysis, the intervention was found to be significantly associated with the improved prescribing (P< .001).

Discussion.

The combination of interdisciplinary teamwork, antibiotic stewardship, education, and information technology is associated with replicable and sustained prescribing improvements.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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