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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*
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 (scosgrol@jhmi.edu)

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
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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