Adenkar Gargi, Raja Karan, Chen Brandon, Beggs Donald, Cilderman Christopher, Patel Mitesh, Philips Mona
Robert Wood Johnson Barnabas Health, Clara Maass Medical Center, Belleville, NJ, USA.
Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Mar 14;5(1):e76. doi: 10.1017/ash.2025.40. eCollection 2025.
Assess the impact of a multifaceted discharge antimicrobial stewardship initiative by comparing proportion of appropriate antimicrobial regimens before and after implementation.
Cohort study.
Non-teaching, urban, community medical center.
Adult patients prescribed an oral antimicrobial regimen at discharge were included. Patients were randomized irrespective of encounter type or discharge disposition. Pregnant and post-partum patients were excluded.
A discharge antimicrobial stewardship program was implemented at our facility. Components of the initiative included development of a comprehensive, institution-specific, inpatient and outpatient prescribing guideline, extensive face-to-face clinician education, and real-time, pharmacist prospective audit and feedback at discharge. The validated National Antimicrobial Prescribing Survey tool was used to then categorize one hundred randomized discharge antimicrobial prescriptions as appropriate (optimal or adequate), inappropriate (suboptimal or inadequate), or not assessable. Hospital-specific treatment guidelines, literature references, and patient-specific factors were used to determine appropriateness.
One hundred antimicrobial regimens selected via random sampling were analyzed in each cohort. The proportion of appropriate antimicrobial regimens increased by 15% after program implementation (47% vs 62%, = .03).
Study results highlight the positive impact of a multidisciplinary, multipronged approach in improving discharge antimicrobial prescribing.
通过比较实施前后适当抗菌药物治疗方案的比例，评估多方面出院抗菌药物管理倡议的影响。
队列研究。
非教学型城市社区医疗中心。
纳入出院时开具口服抗菌药物治疗方案的成年患者。患者无论就诊类型或出院处置方式如何均被随机分组。排除孕妇和产后患者。
我们的机构实施了出院抗菌药物管理计划。该倡议的组成部分包括制定全面的、针对机构的住院和门诊处方指南，广泛的面对面临床医生教育，以及出院时药剂师的实时前瞻性审核和反馈。使用经过验证的国家抗菌药物处方调查工具将100份随机抽取的出院抗菌药物处方分类为适当（最佳或充分）、不适当（次优或不充分）或不可评估。使用医院特定的治疗指南、文献参考和患者特定因素来确定适当性。
每个队列分析了通过随机抽样选择的100种抗菌药物治疗方案。项目实施后，适当抗菌药物治疗方案的比例增加了15%（分别为47%和62%，P = .03）。
研究结果突出了多学科、多管齐下方法在改善出院抗菌药物处方方面的积极影响。
