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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 ,
Shweta Sharma ,
Maryrose DeFino ,
Yi Guo ,
Purvi Shah ,
Susan McAllen ,
Philip Chung ,
Shakara Brown ,
Joseph Paternoster  and
Alan Schechter
...Show all authors
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).
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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
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 6 , June 2013 , pp. 566 - 572
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

REFERENCES

1.Niederman, MS, Mandell, LA, Anzueto, A, et al; American Thoracic Society. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Am J Resp Crit Care Med 2001;163:1730–1754.Google Scholar
2.Hoyert, DL, Heron, MP, Murphy, SL, Kung, HC. Deaths: final data for 2003. Natl Vital Stat Rep 2006;54:(13):1–120.Google Scholar
3.Fine, MJ, Smith, MA, Carson, CA, et al.Prognosis and outcomes of patients with community-acquired pneumonia: a meta-analysis. JAMA 1996;274:134–141.Google Scholar
4. CMS specifications manual. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualitylnits/HospitalRHQDAPU.html. Published 2008. Accessed April 30, 2012.Google Scholar
5.Mandell, LA, Wunderink, RG, Anzueto, A, et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(suppl 2):S27–S72.CrossRefGoogle Scholar
6.Pines, JM. Measuring antibiotic timing for pneumonia in the emergency department: another nail in the coffin. Ann Emerg Med 2007;49(5):561–563.CrossRefGoogle ScholarPubMed
7.Huock, PM, Bratzler, DW, Wato, N, Allen, M, Bartlett, JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004;164:637–644.Google Scholar
8.Drew, RH, Kawamoto, K, Adams, MB. Information technology for optimizing the management of infectious diseases. Am J Health Syst Pharm 2006;63(10):957–965.Google Scholar
9.Lawrence, C, Tuma, R, Guha, S, Hazar, M, Lowy, FD, Shuter, J. Multiple antibiotic changes during the first 72 hours of hospitalization. Am J Med Sci 2001;322(2):61–67.Google Scholar
10.File, T. Current challenges in the treatment of community-acquired pneumonia. Clin Infect Dis 2004;38(suppl 1):S1–S4.Google Scholar
11. US Department of Health and Human Services. Hospital Compare website. 2005. http://www.hospitalcompare.hhs.gov/. Accessed April 30, 2012.Google Scholar
12.Berwick, DM. Continuous quality improvement as an ideal in healthcare. N Engl J Med 1989;320:53–56.Google Scholar
13.Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press, 2001.Google Scholar
14. State and county QuickFacts. US Census Bureau website. 2010. http://quickfacts.census.gov/qfd/states/36/36005.html. Accessed April 30, 2012.Google Scholar
15. Montefiore Medical Center: internal facility data. Accessed May 1, 2012.Google Scholar
16. American Hospital Association 2010. Modern Healthcare Report, Crain's Communication, 2012.Google Scholar
17.Dellit, TH, Owens, RC, McGowan, JE, 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;44:159–177.Google Scholar
18. Pyxis MedStation website, http://www.pyxismedstation.com/. Published August 15, 2011. Accessed May 1, 2012.Google Scholar
19. SPSS website, http://www.manta.eom/c/mm7z120/spss-inc. Accessed May 1, 2012.Google Scholar
20. Centers for Disease Control and Prevention website, http://wwwn.cdc.gov/epiinfo/. Updated October 20, 2011. Accessed May 1, 2012.Google Scholar
21. StataCorp website, http://www.stata.com/. Accessed May 1, 2012.Google Scholar
22.Welker, J. Antibiotic timing and errors in diagnosing pneumonia. Arch Intern Med 2008:168(4):351–356.Google Scholar
23.Polgreen, PM, Chen, YY, Cavanaugh, JE, et al.An outbreak of severe Clostridium difficile–associated disease possibly related to inappropriate antimicrobial therapy for community-acquired pneumonia. Infect Control Hosp Epidemiol 2007:28(2):212–214.Google Scholar
24.ASHP Guidelines on Emergency Medicine Pharmacist Services. ASHP guidelines on the safe use of automated dispensing devices. Am J Health Syst Pharm 2010;67:483–490.Google Scholar
25.Oren, E, Shaffer, ER, Guglielmo, BJ. Impact of emerging technologies on medication errors and adverse drug events. Am J Health Syst Pharm 2003;60:1447–1458.Google Scholar
26.Wu, RC, Laporte, A, Unger, WJ. Cost-effectiveness of an electronic medication ordering and administration system in reducing adverse drug events. J Eval Clin Pract 2007;13:440–448.Google Scholar