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Antimicrobial stewardship programs reduce daily prescribing variability in academic ICUs.
CCCF Academy. Dresser L. 10/25/15; 114781; P
Dr. Linda Dresser
Dr. Linda Dresser
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Topic: Quality Assurance/Quality Improvement Project


Antimicrobial stewardship programs reduce daily prescribing variability in academic ICUs.



Linda Dresser, J. Hughes, M. McIntyre, S. Nelson, N. Ferguson, S. Lapinsky, N. Lazar, S. Mehta, L. Burry, J. Singh, C. Bell, A. Morris

, University Health Network, Dept. of Pharmacy, Toronto, Canada | Centre for Disease Modelling, York University, Toronto, Canada | Pharmacy, Mount Sinai Hospital, Toronto, Canada | Pharmacy, Mount Sinai Hospital, Toronto, Canada | Critical Care, University Health Network, Toronto, Canada | Critical Care, Mount Sinai Hospital, Toronto, Canada | Critical Care, University Health Network, Toronto, Canada | Critical Care, Mount Sinai Hospital, Toronto, Canada | Pharmcay, Mount Sinai Hospital, Toronto, Canada | Critical Care, University Health Network, Toronto, Canada | Medicine, Mount Sinai Hospital, Toronto, Canada | Medicine, Mount Sinai Hospital, Toronto, Canada

Introduction: Antimicrobial stewardship programs (ASP) aim to optimize antimicrobial therapy through knowledge translation and changing prescribing behavior. ASP’s have previously demonstrated an impact on antimicrobial consumption in academic ICU’s but the influence on prescribing patterns has not been measured.1

Objectives:

We examined the impact of an ASP on the variation in daily antimicrobial use before and after implementation in two academic medical-surgical intensive care units. We hypothesized the ASP would decrease variability in antimicrobial prescribing.



Methods: Antimicrobial stewardship using prospective audit and feedback (PAF) rounds was introduced February 2009 in ICU 1 and October 2010 in ICU 2. In each ICU, the ASP PAF rounds initially occurred 5 times per week on weekdays, and decreased to 4 times per week and then 3 times per week after years 1 and 2 respectively. We analyzed daily aggregate consumption of antibiotics and antifungals, measured in Defined Daily Doses (DDDs) per patient day from January 2008 to December 2014. Autoregressive moving average (ARMA) models with heterogeneous errors were used to detect effects of ASP implementation while accounting for temporal autocorrelation, non-stationarity and heteroscedasticity.

Results: Prior to introduction of an ASP there was substantial variation in antibiotic use among days of the week at both sites (p1<0.001, p2<0.001), with lowest use on Saturdays, and highest use on Fridays. At both sites PAF rounds were associated with a significant decrease in daily variability (p1<0.001, p2<0.001).(Figure 1) At site 1 there was also an overall decrease in antibiotic use (p1=0.001, p2=0.07). At Site 2 variation in antibiotic use among weekdays also decreased substantially after PAF (p1=0.87, p2<0.001) with the greatest change on Tuesdays and Fridays. Changing the frequency of PAF rounds did not demonstrably alter variability over the time period examined (p1=0.95, p2=0.2).

Conclusion:

ASP using prospective audit and feedback rounds in academic ICU’s was associated with decreased variability in prescribing patterns. This impact was sustained over time and with a decrease in the ASP intervention frequency.



References:

1. Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. (2011) Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 66: 1223-1230.

P


Topic: Quality Assurance/Quality Improvement Project


Antimicrobial stewardship programs reduce daily prescribing variability in academic ICUs.



Linda Dresser, J. Hughes, M. McIntyre, S. Nelson, N. Ferguson, S. Lapinsky, N. Lazar, S. Mehta, L. Burry, J. Singh, C. Bell, A. Morris

, University Health Network, Dept. of Pharmacy, Toronto, Canada | Centre for Disease Modelling, York University, Toronto, Canada | Pharmacy, Mount Sinai Hospital, Toronto, Canada | Pharmacy, Mount Sinai Hospital, Toronto, Canada | Critical Care, University Health Network, Toronto, Canada | Critical Care, Mount Sinai Hospital, Toronto, Canada | Critical Care, University Health Network, Toronto, Canada | Critical Care, Mount Sinai Hospital, Toronto, Canada | Pharmcay, Mount Sinai Hospital, Toronto, Canada | Critical Care, University Health Network, Toronto, Canada | Medicine, Mount Sinai Hospital, Toronto, Canada | Medicine, Mount Sinai Hospital, Toronto, Canada

Introduction: Antimicrobial stewardship programs (ASP) aim to optimize antimicrobial therapy through knowledge translation and changing prescribing behavior. ASP’s have previously demonstrated an impact on antimicrobial consumption in academic ICU’s but the influence on prescribing patterns has not been measured.1

Objectives:

We examined the impact of an ASP on the variation in daily antimicrobial use before and after implementation in two academic medical-surgical intensive care units. We hypothesized the ASP would decrease variability in antimicrobial prescribing.



Methods: Antimicrobial stewardship using prospective audit and feedback (PAF) rounds was introduced February 2009 in ICU 1 and October 2010 in ICU 2. In each ICU, the ASP PAF rounds initially occurred 5 times per week on weekdays, and decreased to 4 times per week and then 3 times per week after years 1 and 2 respectively. We analyzed daily aggregate consumption of antibiotics and antifungals, measured in Defined Daily Doses (DDDs) per patient day from January 2008 to December 2014. Autoregressive moving average (ARMA) models with heterogeneous errors were used to detect effects of ASP implementation while accounting for temporal autocorrelation, non-stationarity and heteroscedasticity.

Results: Prior to introduction of an ASP there was substantial variation in antibiotic use among days of the week at both sites (p1<0.001, p2<0.001), with lowest use on Saturdays, and highest use on Fridays. At both sites PAF rounds were associated with a significant decrease in daily variability (p1<0.001, p2<0.001).(Figure 1) At site 1 there was also an overall decrease in antibiotic use (p1=0.001, p2=0.07). At Site 2 variation in antibiotic use among weekdays also decreased substantially after PAF (p1=0.87, p2<0.001) with the greatest change on Tuesdays and Fridays. Changing the frequency of PAF rounds did not demonstrably alter variability over the time period examined (p1=0.95, p2=0.2).

Conclusion:

ASP using prospective audit and feedback rounds in academic ICU’s was associated with decreased variability in prescribing patterns. This impact was sustained over time and with a decrease in the ASP intervention frequency.



References:

1. Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. (2011) Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 66: 1223-1230.

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