Enforcing a policy for restricting antimicrobial drug use.

An institution's experience in enforcing a policy for restricting the use of antimicrobial agents is described. A policy to restrict the use of eight intravenous antimicrobial agents had been in place for two years at a large county teaching hospital but had never been enforced. In 1994 an organized effort to enforce the policy was begun. Memorandums were sent to all medical staff, residents, pharmacists, and nurses informing them that the policy would be diligently enforced. Before a restricted antimicrobial could be dispensed, the approval of a physician specializing in infectious diseases was required. Under the direction of the pharmacy and therapeutics committee and an antimicrobial subcommittee, a specially hired team of pharmacists started to encourage more effective and economical prescribing of antimicrobials. During a nine-month period after enforcement began, use of the restricted antimicrobials declined, and use of nonrestricted antimicrobials increased. After two months, acquisition costs for the restricted drugs had been reduced by more than $82,000; however, a similar increase in acquisition costs for nonrestricted antimicrobials occurred. As a result, one nonrestricted agent was reclassified as restricted, and inservice sessions were held to teach prescribes about the appropriate use of another agent. In general, physicians were very compliant with the antimicrobial-restriction policy; the greatest resistance was encountered from surgical residents. Some-pharmacists needed warnings beyond the initial memorandum. Enforcement of an antimicrobial-restriction policy led to decreased use of the restricted drugs and substantial cost avoidance. As new patterns of antimicrobial use emerged, the restriction policy was modified as necessary.