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Description of a pharmacist-driven safety algorithm in Staphylococcus aureus bacteremia: Compliance, interventions, and good saves

Published online by Cambridge University Press:  16 June 2020

Tara H. Lines Open the ORCID record for Tara H. Lines [Opens in a new window] ,
Whitney J. Nesbitt Open the ORCID record for Whitney J. Nesbitt [Opens in a new window] ,
Matthew H. Greene Open the ORCID record for Matthew H. Greene [Opens in a new window]  and
George E. Nelson Open the ORCID record for George E. Nelson [Opens in a new window]
Tara H. Lines*
Affiliation:
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
Whitney J. Nesbitt
Affiliation:
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
Matthew H. Greene
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
George E. Nelson
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
*
Author for correspondence: Tara H. Lines, E-mail: Linesth@gmail.com
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Abstract

Objective:

To evaluate the impact of a pharmacist-driven Staphylococcus aureus bacteremia (SAB) safety bundle supported by leadership and to compare compliance before and after implementation.

Design:

Retrospective cohort study with descriptive and before-and-after analyses.

Setting:

Tertiary-care academic medical center.

Patients:

All patients with documented SAB, regardless of the source of infection, were included. Patients transitioned to palliative care were excluded from before-and-after analysis.

Methods:

A pharmacist-driven safety bundle including documented clearance of bacteremia, echocardiography, removal of central venous catheters, and targeted intravenous therapy of at least 2 weeks duration was implemented in November 2015 and was supported by leadership with stepwise escalation for nonresponse. A descriptive analysis of all patients with SAB during the study period included pharmacy interventions, acceptance rates, and escalation rates. A pre–post implementation analysis of 100 sequential patients compared bundle compliance and descriptive parameters.

Results:

Overall, 391 interventions were made in the 20-month period following implementation, including 20 “good saves” avoiding potentially major adverse events. No statistically significant differences in complete bundle compliance were detected between the periods (74% vs 84%; P = .08). However, we detected a significant increase in echocardiography after the bundle was implemented (83% vs 94%; P = .02) and fewer patients received suboptimal definitive therapy after the bundle was implemented (10% vs 3%; P = .045).

Conclusions:

This pharmacist-driven SAB safety bundle with leadership support showed improvement in process measures, which may have prevented major adverse events, even with available infectious diseases (ID) consultation. It provides a critical safety net for institutions without mandatory ID consultation or with limited antimicrobial stewardship resources.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 8 , August 2020 , pp. 921 - 925
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION. These data were presented in a poster at the Vizient Consortium Pharmacy Network Meeting on December 2, 2017, in Las Vegas, Nevada.

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