Department of Pharmacy, University of Michigan, Ann Arbor, Michigan.
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Infect Control Hosp Epidemiol. 2020 Oct;41(10):1136-1141. doi: 10.1017/ice.2020.236. Epub 2020 Jun 3.
To evaluate whether incorporating mandatory prior authorization for Clostridioides difficile testing into antimicrobial stewardship pharmacist workflow could reduce testing in patients with alternative etiologies for diarrhea.
Single center, quasi-experimental before-and-after study.
Tertiary-care, academic medical center in Ann Arbor, Michigan.
Adult and pediatric patients admitted between September 11, 2019 and December 10, 2019 were included if they had an order placed for 1 of the following: (1) C. difficile enzyme immunoassay (EIA) in patients hospitalized >72 hours and received laxatives, oral contrast, or initiated tube feeds within the prior 48 hours, (2) repeat molecular multiplex gastrointestinal pathogen panel (GIPAN) testing, or (3) GIPAN testing in patients hospitalized >72 hours.
A best-practice alert prompting prior authorization by the antimicrobial stewardship program (ASP) for EIA or GIPAN testing was implemented. Approval required the provider to page the ASP pharmacist and discuss rationale for testing. The provider could not proceed with the order if ASP approval was not obtained.
An average of 2.5 requests per day were received over the 3-month intervention period. The weekly rate of EIA and GIPAN orders per 1,000 patient days decreased significantly from 6.05 ± 0.94 to 4.87 ± 0.78 (IRR, 0.72; 95% CI, 0.56-0.93; P = .010) and from 1.72 ± 0.37 to 0.89 ± 0.29 (IRR, 0.53; 95% CI, 0.37-0.77; P = .001), respectively.
We identified an efficient, effective C. difficile and GIPAN diagnostic stewardship approval model.
评估将艰难梭菌检测的强制性事先授权纳入抗菌药物管理药剂师的工作流程中是否可以减少对具有腹泻替代病因的患者的检测。
单中心、准实验前后研究。
密歇根州安阿伯市的三级保健、学术医疗中心。
2019 年 9 月 11 日至 12 月 10 日期间入院的成人和儿科患者，如果他们有以下之一的医嘱：（1）艰难梭菌酶免疫测定（EIA）在住院时间>72 小时且在过去 48 小时内接受泻药、口服造影剂或开始管饲的患者中，（2）重复分子多重胃肠道病原体面板（GIPAN）检测，或（3）在住院时间>72 小时的患者中进行 GIPAN 检测。
实施了抗菌药物管理计划（ASP）对 EIA 或 GIPAN 检测进行事先授权的最佳实践警报。批准要求提供者给 ASP 药剂师打电话并讨论检测的理由。如果未获得 ASP 批准，则提供者不得进行该订单。
在 3 个月的干预期间，平均每天收到 2.5 份请求。EIA 和 GIPAN 订单的每周每 1000 患者天的数量从 6.05 ± 0.94 显著减少到 4.87 ± 0.78（IRR，0.72；95%CI，0.56-0.93；P =.010）和从 1.72 ± 0.37 到 0.89 ± 0.29（IRR，0.53；95%CI，0.37-0.77；P =.001）。
我们确定了一种有效的艰难梭菌和 GIPAN 诊断管理审批模式。
