Implementation of a care bundle for antimicrobial stewardship

Henry Ford West Bloomfield Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists (Impact Factor: 1.88). 05/2010; 67(9):746-9. DOI: 10.2146/ajhp090259
Source: PubMed


The impact of an antibiotic-use care bundle on compliance with quality indicators was evaluated.
Patients admitted to the internal medicine or surgery floor of a tertiary care center who were receiving an anti-pseudomonal beta-lactam, vancomycin, a fluoroquinolone, linezolid, an amino-glycoside, or any combination of these agents were included in the study. The study consisted of two phases: intervention (when a stewardship pharmacist was involved in patient care) and control (when no stewardship pharmacist was involved). The stewardship pharmacist completed interventions via prospective audit and suggested changes to empirical and definitive antimicrobials, monitored patients' cultures and antimicrobial therapy daily, and provided education on the institution's antibiogram. The primary outcome measured was compliance with the care bundle's quality indicators, which included documentation of treatment rationale, collection of appropriate culture specimens according to institutional and national guidelines, appropriate empirical selection of antibiotics according to institutional and national guidelines at initiation of antibiotic therapy and deescalation, and selection of appropriate agents for definitive therapy during antimicrobial therapy.
A total of 160 patients and 442 antibiotic orders were evaluated. During the intervention phase, 168 interventions were made, with an acceptance rate of 91%. The rate of appropriate deescalation rose from 72% to 90% (p = 0.01). Compliance with all quality indicators rose from 16% to 43% (p < 0.001).
Implementation of an antimicrobial stewardship program care bundle on two patient care units was associated with improved rates of compliance with quality indicators.

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    • "Such guidelines can be directly used or form the basis of hospital-level antimicrobial use guidelines. The impact of national or international guidelines is difficult to assess, but implementation of antimicrobial use guidelines at the hospital level has been shown to significantly improve antimicrobial prescribing practices, either alone or as part of a broader antimicrobial stewardship program [3–5]. "
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