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Many health care facilities do not have antimicrobial stewardship programs in place.
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Antimicrobial stewardship ward rounds offer an efficient way to improve the acceptance of stewardship recommendations.
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Patients that report penicillin allergies often receive suboptimal treatment for infectious conditions so performing interventions to better identify those patients with true allergies, including penicillin skin testing, offer promise to providing more optimal care.
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Patient transitions in care
Antimicrobial Stewardship Interventions: Thinking Inside and Outside the Box
Section snippets
Key points
Antimicrobial stewardship ward rounds
Many health care facilities have moved from a more tightly restricted system requiring preprescription authorization to a model that incorporates less restricted antimicrobial use up front but coupled with prospective audit and feedback, also know as postprescription review and feedback. Prospective audit and feedback to providers can be an effective method to improve judicious antimicrobial use. Many studies have shown significant reductions in inappropriate antimicrobial use, increases in
Improving the efficiency of prospective audit and feedback
Prospective audit and feedback can be daunting. The rate of inappropriate antibiotic use is estimated to range between 14% and 43% of all prescriptions.11 It is estimated that the average hospital uses 839 antibiotic days of therapy per 1000 patient-days; there are almost enough antibiotics for every hospitalized patient to receive a full daily dose of an antibiotic each day.12 The ability to effectively identify patients for prospective audit and feedback has prevented many centers from
Antimicrobial stewardship and antibiotic allergies
Often neglected but imperative considerations in antimicrobial stewardship are antibiotic allergies. Medication allergies are common, and of all antibiotic allergies penicillin is the most common, reported in 5% to 10% of patients.20 When treated for infections, patients with reported penicillin allergies often receive broader-spectrum, suboptimal, and even more toxic agents than patients without reported penicillin allergies. In addition, many alternative agents to β-lactams such as vancomycin
Antimicrobial stewardship at transitions in care
One area that has largely been excluded from stewardship interventions are transitions of care from one setting to another. It has long been recognized that patients are particularly vulnerable when they change from one patient care location to another or to home. Mistakes are often made when preparing a patient’s discharge medications. These pervasive mistakes include incorrect dosage, incorrect therapeutic drug monitoring, incorrect duration, and incorrect medication choice. Furthermore,
Antimicrobial stewardship at the end of life
Hospice promotes palliative care for patients who are terminally or seriously ill, and provides a noble way for these patients to approach the end of life. This philosophy of medical care shifts focus from aggressive treatments and diagnostic procedures to comfort. In this setting, medications and procedures that do not align with this philosophy are discontinued. As in almost all other health care settings, however, antimicrobial agents are perceived differently from other medications and are
Stewardship at the level of prescriber or unit
Guidelines and recommendations for antimicrobial stewardship have focused on the creation of centralized processes and infrastructure to promote judicious antimicrobial use (see Table 1). These programs generally require dedicated and trained personnel to regulate and monitor antimicrobial use. Many health care facilities lack resources and dedicated personnel to perform stewardship activities; therefore, stewardship is limited in most health care facilities. However, it may not be necessary to
Summary
Imprudent antimicrobial use is pervasive in the current health care environment. Relying on traditional methods of antimicrobial stewardship alone will not significantly limit inappropriate antibiotic use in the myriad health care settings. Identifying the areas where most inappropriate antibiotic use exists allows antimicrobial stewardship teams to leverage their resources most efficiently. Electronic alerts can broaden the scope of the audit process but also allow centers without significant
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Cited by (32)
Collaborative Antimicrobial Stewardship: Working with Hospital and Health System Administration
2020, Infectious Disease Clinics of North AmericaCitation Excerpt :Whenever possible, align goals with issues that are viewed by administration as important or so-called burning-platform issues. Apply innovation to the request: think about so-called outside-the-box opportunities.23 Avoid business plans that focus solely on eliminating medication costs.24
Journal Club: Antibiotic information application offers nurses quick support
2016, American Journal of Infection ControlAntimicrobial Stewardship: Hospital Strategies to Curb Antibiotic Resistance. Hospital Strategies to Curb Antibiotic Resistance
2016, Antibiotic Resistance: Mechanisms and New Antimicrobial ApproachesAntimicrobial stewardship across 47 South African hospitals: an implementation study
2016, The Lancet Infectious DiseasesCitation Excerpt :We believe stewardship should be approached by means of a stepwise implementation of process improvement initiatives and principles targeted to institutional needs. By focusing on the so-called vital few (interventions),24 health-care facilities with limited resources and infectious diseases and microbiology expertise can have a substantial effect on antibiotic use with less effort, while embedding antimicrobial stewardship practices within existing resource structures and systems. This focus on key interventions ensures sustainability and provides a platform for targeting more complex stewardship interventions in the future.
Physician Perceptions Regarding Antimicrobial Use in End-of-Life Care
2018, Infection Control and Hospital EpidemiologyGamified antimicrobial decision support app (GADSA) changes antibiotics prescription behaviour in surgeons in Nigeria: a hospital-based pilot study
2023, Antimicrobial Resistance and Infection Control
Disclosures: Neither author has anything to disclose.