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Impact of unit-specific metrics and prescribing tools on a family medicine ward

Published online by Cambridge University Press:  01 July 2020

Nicholas J. Mercuro
Affiliation:
Henry Ford Hospital, Department of Pharmacy Practice, DetroitMichigan Wayne State University, Eugene Applebaum College of Pharmacy, Detroit, Michigan Beth Israel Deaconess Medical Center, Boston, Massachusetts
Thomas P. Lodise
Affiliation:
Albany College of Pharmacy and Health Sciences, Department of Pharmacy, Albany, New York
Rachel M. Kenney
Affiliation:
Henry Ford Hospital, Department of Pharmacy Practice, DetroitMichigan
Berta Rezik
Affiliation:
Henry Ford Hospital, Department of Family Medicine, Wayne State University, Michigan
Raghavendra C. Vemulapalli
Affiliation:
Henry Ford Hospital, Department of Family Medicine, Wayne State University, Michigan
Mariam J. Costandi
Affiliation:
Henry Ford Hospital, Department of Family Medicine, Wayne State University, Michigan
Susan L. Davis*
Affiliation:
Henry Ford Hospital, Department of Pharmacy Practice, DetroitMichigan Wayne State University, Eugene Applebaum College of Pharmacy, Detroit, Michigan
*
Author for correspondence: Susan L. Davis, E-mail: sldavis@wayne.edu

Abstract

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.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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