Impact of unit-specific metrics and prescribing tools on a family medicine ward
| Autor: | Nicholas J Mercuro, Thomas P. Lodise, Berta Rezik, Rachel M. Kenney, Mariam J. Costandi, Raghavendra C. Vemulapalli, Susan L. Davis |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
0301 basic medicine Microbiology (medical) medicine.medical_specialty Epidemiology 030106 microbiology Single Center Drug Prescriptions Unit (housing) Antimicrobial Stewardship 03 medical and health sciences 0302 clinical medicine Intervention (counseling) medicine Humans Antimicrobial stewardship 030212 general & internal medicine Clinical failure Respiratory Tract Infections Process Measures End point Respiratory tract infections business.industry Anti-Bacterial Agents Benchmarking Infectious Diseases Family medicine Family Practice business |
| Zdroj: | Infection Control & Hospital Epidemiology. 41:1272-1278 |
| ISSN: | 1559-6834 0899-823X |
| DOI: | 10.1017/ice.2020.288 |
| Popis: | Objective:Prescribing metrics, cost, and surrogate markers are often used to describe the value of antimicrobial stewardship (AMS) programs. However, process measures are only indirectly related to clinical outcomes and may not represent the total effect of an intervention. We determined the global impact of a multifaceted AMS initiative for hospitalized adults with common infections.Design:Single center, quasi-experimental study.Methods:Hospitalized adults with urinary, skin, and respiratory tract infections discharged from family medicine and internal medicine wards before (January 2017–June 2017) and after (January 2018–June 2018) an AMS initiative on a family medicine ward were included. A series of AMS-focused initiatives comprised the development and dissemination of: handheld prescribing tools, AMS positive feedback cases, and academic modules. We compared the effect on an ordinal end point consisting of clinical resolution, adverse drug events, and antimicrobial optimization between the preintervention and postintervention periods.Results:In total, 256 subjects were included before and after an AMS intervention. Excessive durations of therapy were reduced from 40.3% to 22% (P < .001). Patients without an optimized antimicrobial course were more likely to experience clinical failure (OR, 2.35; 95% CI, 1.17–4.72). The likelihood of a better global outcome was greater in the family medicine intervention arm (62.0%, 95% CI, 59.6–67.1) than in the preintervention family medicine arm.Conclusion:Collaborative, targeted feedback with prescribing metrics, AMS cases, and education improved global outcomes for hospitalized adults on a family medicine ward. |
| Databáze: | OpenAIRE |
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