Skip to main content Accessibility help
×
Home

Outcomes of an electronic medical record (EMR)–driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the “Five Moments of Antimicrobial Prescribing”

  • Misha Devchand (a1) (a2), Andrew J. Stewardson (a3) (a4), Karen F. Urbancic (a1) (a2) (a5), Sharmila Khumra (a1) (a2), Andrew A. Mahony (a1), Steven Walker (a1) (a2), Kent Garrett (a2), M. Lindsay Grayson (a1) (a6) and Jason A. Trubiano (a1) (a5) (a6)...

Abstract

Objective:

The primary objective of this study was to examine the impact of an electronic medical record (EMR)–driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed “5 Moments of Antimicrobial Prescribing” metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.

Methods:

A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS recommendation was made. The impact of the ICU-AMS round on antimicrobial appropriateness was evaluated using point-prevalence survey data.

Results:

For the 202 patients, 412 recommendations were made in accordance with the “5 Moments” metric. The most common recommendation made by the ICU-AMS team was moment 3 (discontinuation), which comprised 173 of 412 recommendations (42.0%), with an acceptance rate of 83.8% (145 of 173). Data collected for point-prevalence surveys showed an increase in prescribing appropriateness from 21 of 45 (46.7%) preintervention (October 2016) to 30 of 39 (76.9%) during the study period (September 2017).

Conclusions:

The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our “5 Moments of Antimicrobial Prescribing” metric provides a framework for measuring AMS recommendation compliance.

Copyright

Corresponding author

Author for correspondence: Misha Devchand, Department of Infectious Diseases, Austin Health, PO Box 5555, Heidelberg VIC Australia. E-mail: misha.devchand@austin.org.au

References

Hide All
1. Vincent, J, Rello, J, Marshall, J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:23232329.
2. Luyt, CE, Bréchot, N, Trouillet, JL, et al. Antibiotic stewardship in the intensive care unit. Crit Care 2014;18:480.
3. Katsios, CM, Burry, L, Nelson, S, et al. An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients. Crit Care 2012;16:R216.
4. Adhikari, S, Piza, M, Taylor, P, et al. Sustained multimodal antimicrobial stewardship in an Australian tertiary intensive care unit from 2008–2015: an interrupted time-series analysis. Int J Antimicrob Agents 2018;51:620628.
5. Cairns, KA, Bortz, HD, Le, A, et al. ICU antimicrobial stewardship (AMS) rounds: the daily activities of an AMS service. Int J Antimicrob Agents 2016;48:575576.
6. Cairns, KA, Jenney, AW, Abbott, IJ, et al. Prescribing trends before and after implementation of an antimicrobial stewardship program. Med J Aust 2013;198:262626.
7. Alvarez-Lerma, F, Grau, S, Echeverria-Esnal, D, et al. A before-and-after study of the effectiveness of an antimicrobial stewardship program in critical care. Antimicrob Agents Chemother 2018;62(4):pii–e0182517.
8. Khdour, MR, Hallak, HO, Aldeyab, MA, et al. Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study. Br J Clin Pharmacol 2018;84:708715.
9. Pogue, JM, Potoski, BA, Postelnick, M, et al. Bringing the “power” to Cerner’s PowerChart for antimicrobial stewardship. Clin Infect Dis 2014;59:416424.
10. Micallef, C, Chaudhry, NT, Holmes, AH, et al. Secondary use of data from hospital electronic prescribing and pharmacy systems to support the quality and safety of antimicrobial use: a systematic review. J Antimicrob Chemother 2017;72:18801885.
11. James, R, Upjohn, L, Cotta, M, et al. Measuring antimicrobial prescribing quality in Australian hospitals: development and evaluation of a national antimicrobial prescribing survey tool. J Antimicrob Chemother 2015;70:19121918.
12. Spivak, ES, Cosgrove, SE, Srinivasan, A. Measuring appropriate antimicrobial use: attempts at opening the black box. Clin Infect Dis 2016;63:16391644.
13. Dresser, LD, Bell, CM, Steinberg, M, et al. Use of a structured panel process to define antimicrobial prescribing appropriateness in critical care. J Antimicrob Chemother 2018;73:246249.
14. Dellit, TH, Owens, RC, McGowan, JE Jr, 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;44:159177.
15. James, RS, McIntosh, KA, Luu, SB, et al. Antimicrobial stewardship in Victorian hospitals: a statewide survey to identify current gaps. Med J Aust 2013;199:692695.
16. DiazGranados, CA. Prospective audit for antimicrobial stewardship in intensive care: impact on resistance and clinical outcomes. Am J Infect Control 2012;40:526529.
17. Elligsen, M, Walker, SA, Pinto, R, et al. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infect Control Hosp Epidemiol 2012;33:354361.
18. Weiss, CH, Dibardino, D, Rho, J, et al. A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization. Crit Care Med 2013;41:25632569.
19. Cresswell, K, Mozaffar, H, Shah, S, et al. Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review. Int J Pharm Pract 2017;25:517.
20. Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51e77.
21. Morris, AM. Antimicrobial stewardship programs: appropriate measures and metrics to study their impact. Curr Treat Options Infect Dis 2014;6:101112.
22. Broom, J, Broom, A, Plage, S, et al. Barriers to uptake of antimicrobial advice in a UK hospital: a qualitative study. J Hosp Infect 2016;93:418422.
Type Description Title
WORD
Supplementary materials

Devchand et al. supplementary material
Devchand et al. supplementary material

 Word (41 KB)
41 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed