Siegfried Justin, Merchan Cristian, Scipione Marco R, Papadopoulos John, Dabestani Arash, Dubrovskaya Yanina
Department of Pharmacy, NYU Langone Medical Center, New York, NY.
Department of Pharmacy, NYU Langone Medical Center, New York, NY
Am J Health Syst Pharm. 2017 Mar 15;74(6):417-423. doi: 10.2146/ajhp160133.
The integration of pharmacy residents into an antimicrobial stewardship program (ASP) is described, and data on the residents' ASP interventions and outcomes are reported.
ASP coverage of nighttime, holiday, and weekend shifts is often provided by infectious diseases (ID) medical fellows and staff pharmacists, potentially leading to inconsistent stewardship practices. As part of an initiative by a large urban hospital to provide around-the-clock, comprehensive ASP services 7 days a week, postgraduate year 2 (PGY2) pharmacy residents in ID or critical care were assigned to provide ASP coverage on weekends. Over a 12-month period, residents providing ASP weekend coverage documented a total of 1,443 interventions, of which 1,000 (69%) were pursuant to 72-hour prospective audit and feedback review and 443 (31%) occurred during ASP phone coverage. A comparison of overall antimicrobial utilization (mean ± S.D. days of therapy [DOT] per 1,000 patient-days [PD]) before and after implementation of resident ASP coverage on weekends showed a decrease in aggregate antimicrobial use from 799.3 ± 46.8 to 740.7 ± 17.3 DOT/1,000 PD (a difference of 58.6 DOT/1,000 PD, = 0.08), with a corresponding decline in the incidence of hospital-onset infection (from 1.18 cases to 0.9 case per 1,000 PD).
By expanding the hospital's ASP services by assigning PGY2 pharmacy residents to weekend coverage, the institution was able to provide high-level clinical care 7 days per week, which benefited both patients and PGY2 pharmacy residents while meeting national ASP regulatory requirements.
描述药学住院医师融入抗菌药物管理计划（ASP）的情况，并报告住院医师ASP干预措施及结果的数据。
夜间、节假日和周末班次的ASP覆盖通常由传染病（ID）医学研究员和药剂师提供，这可能导致管理措施不一致。作为一家大型城市医院每周7天提供全天候综合ASP服务倡议的一部分，ID或重症监护领域的二年级药学住院医师（PGY2）被分配在周末提供ASP覆盖。在12个月的时间里，提供ASP周末覆盖的住院医师共记录了1443次干预措施，其中1000次（69%）是根据72小时前瞻性审核和反馈审查进行的，443次（31%）发生在ASP电话覆盖期间。对周末实施住院医师ASP覆盖前后的总体抗菌药物使用情况（每1000患者日[PD]的平均±标准差治疗天数[DOT]）进行比较，结果显示抗菌药物总使用量从799.3±46.8降至740.7±17.3 DOT/1000 PD（差异为58.6 DOT/1000 PD，P = 0.08），医院获得性感染的发生率相应下降（从每1000 PD 1.18例降至0.9例）。
通过分配PGY2药学住院医师进行周末覆盖来扩大医院的ASP服务，该机构能够每周7天提供高水平的临床护理，这对患者和PGY2药学住院医师都有益，同时满足了国家ASP监管要求。
