Evaluating the Impact of a Pharmacist-Led Antimicrobial Stewardship Intervention at Discharge in a Community, Nonteaching Hospital.

Autor:	Manis MM; Department of Pharmacy Practice, Samford University McWhorter School of Pharmacy, Birmingham, AL, USA., Kyle JA; Department of Pharmacy Practice, Samford University McWhorter School of Pharmacy, Birmingham, AL, USA., Dajani D; Department of Pharmacy, Shelby Baptist Medical Center, Alabaster, AL, USA., Pan K; Department of Economics, Finance, and Quantitative Analysis, Samford University Brock School of Business, Birmingham, AL, USA., Hughes PJ; Department of Pharmacy Practice, Samford University McWhorter School of Pharmacy, Birmingham, AL, USA., Adunlin G; Department of Pharmaceutical, Social, and Administrative Sciences, Samford University McWhorter School of Pharmacy, Birmingham, AL, USA., Allen LN; Southview Medical Group, PC, Birmingham, AL, USA., Leonard CE; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jazyk:	angličtina
Zdroj:	The Annals of pharmacotherapy [Ann Pharmacother] 2023 Mar; Vol. 57 (3), pp. 292-299. Date of Electronic Publication: 2022 Jul 19.
DOI:	10.1177/10600280221111795
Abstrakt:	Introduction: Approximately 30% to 50% of hospital discharge antimicrobials are inappropriate. Limited data exist on approaches to improve antimicrobial prescribing practices at the time of discharge from a community hospital. Objective : To assess the impact of a comprehensive pharmacist-led antimicrobial stewardship intervention at discharge. Methods: We conducted a quasi-experimental, pre-post study. A biphasic intervention took place on 2 medicine units from November 2019 to May 2020 at a community hospital. Baseline data were collected, followed by prescriber education on antimicrobial stewardship to both units (education phase). Next, a pharmacist-led intervention took place on one unit (intervention phase). The primary outcome was composite appropriateness of an oral antimicrobial prescribed to an adult at the time of discharge, defined by narrow spectrum of activity, dosing, and duration of therapy. The primary outcome was assessed using Fisher exact test. Results: Baseline composite appropriateness was 30% (n = 12) on the control unit and 30.8% (n = 20) on the intervention unit. From baseline to posteducation, no significant change in composite appropriateness was found on the control (30% to 26.7%, P = 0.256) or intervention (30.8% to 19.4%, P = 0.09) unit. There was no significant difference between the education to intervention phase (26.7% vs 35%, P = 0.254) on the control unit. On the intervention unit, a significant difference in composite appropriateness was found from the education to intervention phase (19.4% vs 47.8%, P = 0.017). Conclusion and Relevance: A pharmacist-led intervention improved appropriateness of oral antimicrobials prescribed at discharge. One-time education was insufficient for improving antimicrobial stewardship.
Databáze:	MEDLINE
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