Handshake Stewardship A Highly Effective Rounding-based Antimicrobial Optimization Service
Handshake Stewardship A Highly Effective Rounding-based Antimicrobial Optimization Service
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DOI：
10.1097/inf.0000000000001245
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发表时间：
2016-10-01
影响因子：
3.6
通讯作者：
Parker, Sarah K.
中科院分区：
文献类型：
--
作者：
Hurst, Amanda L.;Child, Jason;Parker, Sarah K.
背景：建议实施抗菌药物管理计划，作为对抗日益增加的抗菌药物耐药性的一种解决方案。大多数抗菌药物管理计划使用国家指南中推荐的预授权或限制性策略。我们描述了一个独特的，基于轮的策略，握手管理。握手管理的特点是：（1）缺乏限制和预先授权，（2）审查所有处方的抗菌药物，（3）由药剂师-医生团队进行基于回合的面对面反馈。方法：我们回顾性地测量了在实施前、计划、以及握手管理方法的实施后阶段，以确定该策略在独立儿童医院减少使用的有效性。2010年10月至2014年9月期间住院服务中处方的所有抗菌药物均纳入审查。每月抗菌药物使用（全医院和各单位）以每1000患者日的治疗天数测量（DOT/1000 PD）。在4年的分析中，抗菌药物的总体使用减少了10.9%。（942 ~ 839 DOT/1000 PD，P < 0.01），对抗菌药物的影响为10.3%（750 ~ 673 DOT/1000 PD，P < 0.01）。万古霉素使用率下降25.7%（105 ~ 78 DOT/1000 PD，P < 0.01）。美罗培南的使用减少了22.2%（45至35 DOT/1000 PD，P = 0.04），而其他抗假单胞菌药物的使用没有代偿性增加。减少使用观察到整个医院和个别单位的大多数agents.Conclusions：握手管理的方法是一种有效的策略，抗菌药物管理计划，广泛传播和显着减少抗菌药物的使用后，实施。
Background: Implementation of an antimicrobial stewardship program is recommended as one solution to combat increasing antimicrobial resistance. Most antimicrobial stewardship programs use preauthorization or restrictive strategies recommended in national guidelines. We describe a unique, rounding-based strategy, handshake stewardship. Handshake stewardship is distinguished by: (1) lack of restriction and preauthorization, (2) review of all prescribed antimicrobials and (3) a rounding-based, in-person approach to feedback by a pharmacist-physician team.Methods: We retrospectively measured antimicrobial use hospital-wide and by unit during preimplementation, planning, and postimplementation phases of the handshake stewardship approach to determine the efficacy of this strategy in decreasing use in a freestanding children's hospital. All antimicrobials prescribed on the inpatient services between October 2010 and September 2014 were included in the review. Monthly antimicrobial use (hospital-wide and by unit) was measured in days of therapy per 1000 patient days (DOT/1000 PD).Results: Overall antimicrobial use decreased by 10.9% during the 4 years of the analysis (942 to 839 DOT/1000 PD, P < 0.01), with an impact of 10.3% on antibacterials (750 to 673 DOT/1000 PD, P < 0.01). Vancomycin use decreased by 25.7% (105 to 78 DOT/1000 PD, P < 0.01). Meropenem use decreased by 22.2% (45 to 35 DOT/1000 PD, P = 0.04) without a compensatory increase of other antipseudomonal agents. Decreased usage was observed both hospital-wide and on individual units for most agents.Conclusions: The handshake stewardship approach is an effective strategy for an antimicrobial stewardship program, as demonstrated by the wide-spread and significant decrease in antimicrobial use after implementation.