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Antimicrobial Stewardship and Automated Pharmacy Technology Improve Antibiotic Appropriateness for Community-Acquired Pneumonia

Belinda Ostrowsky MD MPH FSHEA, Shweta Sharma MD MPH, Maryrose DeFino RN MS CPHQ, Yi Guo PharmD, Purvi Shah MD MS, Susan McAllen RN MSOL CEN CPEN, Philip Chung PharmD MS, Shakara Brown MPH, Joseph Paternoster RN, Alan Schechter MD, Brandon Yongue PhD and Rohit Bhalla MD MPH
Infection Control and Hospital Epidemiology
Vol. 34, No. 6 (June 2013), pp. 566-572
DOI: 10.1086/670623
Stable URL: http://www.jstor.org/stable/10.1086/670623
Page Count: 7
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Antimicrobial Stewardship and Automated Pharmacy Technology Improve Antibiotic Appropriateness for Community-Acquired Pneumonia
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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 defined 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 (). 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 (). 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 ().Discussion. The combination of interdisciplinary teamwork, antibiotic stewardship, education, and information technology is associated with replicable and sustained prescribing improvements.

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