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

Published online by Cambridge University Press:  13 August 2019

Misha Devchand
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
Andrew J. Stewardson
Affiliation:
Department of Infectious Diseases, The Alfred Hospital, VIC, Australia Central Clinical School, Monash University, Australia
Karen F. Urbancic
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Pharmacy Department, Austin Health, Heidelberg, VIC, Australia The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, VIC, Australia
Sharmila Khumra
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
Andrew A. Mahony
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
Steven Walker
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
Kent Garrett
Affiliation:
Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
M. Lindsay Grayson
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Medicine (Austin Health), University of Melbourne, Parkville, VIC, Australia
Jason A. Trubiano
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, VIC, Australia Department of Medicine (Austin Health), University of Melbourne, Parkville, VIC, Australia
Corresponding

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.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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