Antimicrobial stewardship and automated pharmacy technology improve antibiotic appropriateness for community-acquired pneumonia

Belinda Ostrowsky, Shweta Sharma, Maryrose Defino, Yi Guo, Purvi D. Shah, Susan McAllen, Philip Chung, Shakara Brown, Joseph Paternoster, Alan L. Schechter, Brandon G. Yongue, Rohit Bhalla

Research output: Contribution to journalArticle

21 Citations (Scopus)

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 (P <.001). 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 (P =.004). 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 (P <.001). discussion. The combination of interdisciplinary teamwork, antibiotic stewardship, education, and information technology is associated with replicable and sustained prescribing improvements.

Original languageEnglish (US)
Pages (from-to)566-572
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume34
Issue number6
DOIs
StatePublished - Jun 2013

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Pharmaceutical Technology
Pneumonia
Hospital Emergency Service
Anti-Bacterial Agents
Centers for Medicare and Medicaid Services (U.S.)
Quality Improvement
Communicable Diseases
Inpatients
Logistic Models
Regression Analysis
Technology
Education

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

Cite this

Antimicrobial stewardship and automated pharmacy technology improve antibiotic appropriateness for community-acquired pneumonia. / Ostrowsky, Belinda; Sharma, Shweta; Defino, Maryrose; Guo, Yi; Shah, Purvi D.; McAllen, Susan; Chung, Philip; Brown, Shakara; Paternoster, Joseph; Schechter, Alan L.; Yongue, Brandon G.; Bhalla, Rohit.

In: Infection Control and Hospital Epidemiology, Vol. 34, No. 6, 06.2013, p. 566-572.

Research output: Contribution to journalArticle

Ostrowsky, B, Sharma, S, Defino, M, Guo, Y, Shah, PD, McAllen, S, Chung, P, Brown, S, Paternoster, J, Schechter, AL, Yongue, BG & Bhalla, R 2013, 'Antimicrobial stewardship and automated pharmacy technology improve antibiotic appropriateness for community-acquired pneumonia', Infection Control and Hospital Epidemiology, vol. 34, no. 6, pp. 566-572. https://doi.org/10.1086/670623
Ostrowsky, Belinda ; Sharma, Shweta ; Defino, Maryrose ; Guo, Yi ; Shah, Purvi D. ; McAllen, Susan ; Chung, Philip ; Brown, Shakara ; Paternoster, Joseph ; Schechter, Alan L. ; Yongue, Brandon G. ; Bhalla, Rohit. / Antimicrobial stewardship and automated pharmacy technology improve antibiotic appropriateness for community-acquired pneumonia. In: Infection Control and Hospital Epidemiology. 2013 ; Vol. 34, No. 6. pp. 566-572.
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