Bohn Brian C, Neuner Elizabeth A, Athans Vasilios, Rivard Kaitlyn R, Riffle Allison R, Richter Sandra S, Fraser Thomas G, Gordon Steven M
Department of Pharmacy, Norton Healthcare, Louisville, KY, USA.
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA.
J Pharm Pract. 2022 Aug;35(4):541-545. doi: 10.1177/0897190021997008. Epub 2021 Mar 2.
In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services.
This single-center, quasi-experimental study included data from weekends before (9/2017-11/2017) and after (9/2018-11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes.
During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes.
Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services.
2018年9月，该学术医疗中心扩大了药学抗菌药物管理（AMS）服务，将周末也纳入其中。AMS药剂师在周末开展的活动包括血培养快速诊断（RDT）审查、抗逆转录病毒疗法（ART）审查、利用临床决策支持进行前瞻性审核与反馈（PAF）、万古霉素给药以及运营支持。本研究的目的是评估这些扩展的AMS服务在运营和临床方面的影响。
这项单中心准实验研究纳入了实施前（2017年9月至2017年11月）和实施后（2018年9月至2018年11月）周末的数据。描述性主要结局仅为实施后组中每种AMS活动类型完成的活动数量。次要结局包括AMS机会解决时间、PAF或RDT警报后升级或降级时间、解决其他AMS相关机会的时间、住院时间（LOS）以及抗菌药物使用结局。
在实施后期间共完成了1258项活动，平均每个周末97项。实施前有72例患者、实施后有59例患者符合解决时间结局的纳入标准。AMS机会解决的中位（IQR）时间从干预前的18.5小时（7.7 - 35.7）降至干预后的8.5小时（IQR 1.8 - 14.0），p < 0.01。升级时间为11.6小时，而之前为1.7小时（p = 0.1），降级时间为16.7小时，而之前为10.8小时（p = 0.03），其他机会时间为40.8小时，而之前为13.2小时（p = 0.01）。住院时间或抗菌药物使用结局未观察到差异。
药剂师主导的周末AMS服务显著缩短了AMS机会的解决时间。这些数据支持了周末AMS服务的价值。
