Infection Control & Hospital Epidemiology (2018), 39, 980–982 doi:10.1017/ice.2018.130
Concise Communication
Improved rates of antimicrobial stewardship interventions following implementation of the Epic antimicrobial stewardship module
Natasha N. Pettit PharmD1, Zhe Han PharmD1, Anish R. Choksi PharmD1, Angella Charnot-Katsikas MD2, Kathleen G. Beavis MD2, Vera Tesic MD2, Palak Bhagat PharmD1, Cynthia T. Nguyen PharmD1,
Allison H. Bartlett MD3 and Jennifer Pisano MD4 1Department of Pharmacy, University of Chicago Medical Center, Chicago, Illinois, 2Department of Pathology, University of Chicago Medical Center, Chicago, Illinois, 3Pediatric Infectious Diseases and Global Health Division, University of Chicago Medical Center, Chicago, Illinois and 4Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois
Abstract
We evaluated the impact of the Epic antimicrobial stewardship module (EAM) on the number of interventions, antimicrobial usage, and clinical outcomes. Use of the EAM allowed us to significantly increase the number of ASP antimicrobial reviews and interventions while maintaining a sustained impact on antimicrobial utilization.
(Received 11 December 2017; accepted 9 May 2018; electronically published June 28, 2018)
Antimicrobial stewardship programs (ASPs) optimize anti- microbial usage by facilitating safe, efficacious, and judicious use.1,2 As of January 2017, the Joint Commission requires all hospitals to have an ASP. The required standards are based on CDC core elements, including monitoring antimicrobial usage and interventions (eg, prospective review/feedback, automatic alerts to streamline therapy).3,4 The ability to meet requirements is contingent upon the ability to identify patients requiring intervention and having an optimal strategy for documenting recommendations. Clinical decision support systems, such as the Epic Antimicrobial Stewardship Module (EAM, Epic Systems, Verona, WI), provide a mechanism for ASPs to quickly identify patients based on current therapy and laboratory results, while also allowing for efficient documentation of activities. We sought to determine the impact of implementing the EAM on the number of interventions made by ASP. Additionally, we evaluated overall utilization of target antimicrobials, antimicrobial expen- ditures, mortality, and length of stay (LOS) among patients receiving antimicrobials.
Methods
This study was a single-center, retrospective cohort study performed at the University of Chicago Medicine, an 811-bed tertiary-care center. The institutional review board approved this
Author for correspondence: Natasha N. Pettit, PharmD, BCPS (AQ-ID), 5841 S Maryland Ave, Chicago, IL 60605. E-mail:
natasha.pettit@
uchospitals.edu
Cite this article: Pettit NN, et al. (2018). Improved rates of antimicrobial stewardship interventions following implementation of the Epic antimicrobial stewardship module. Infection Control & Hospital Epidemiology 2018, 39, 980–982. doi: 10.1017/ice.2018.130
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
study. Our medical center has had an established ASP since 2010, which consists of 2 infectious diseases (ID) physicians and 3 ID pharmacists performing daily antimicrobial stewardship activities. Clinical microbiologists and infection control providers are also active members. A daily review of a list of patients meeting cri- teria for review (based on active orders for antimicrobials, culture data) is performed Monday through Friday. Prior to EAM implementation, an average of 0.5–1 hours per day was needed to identify patients for review by filtering a pharmacy report gen- erated based on antimicrobial orders and manually adding patients to a separate database (ie, an Excel spreadsheet) for documentation. We also utilized an ‘in-basket’ feature in the electronic medical record (EMR) that provided messages to the ASP pharmacist whenever a patient had a blood culture with Staphylococcus aureus or yeast, or if they were growing an organism in culture with incongruent susceptibilities with active antimicrobials (ie, pathogen–drug mismatch). The EAM was implemented July 7, 2015, utilizing specific
criteria to generate a list of alerts for review. The alerts include (1) new start restricted antimicrobial, (2) intravenous to oral administration, (3) azole therapeutic drug monitoring, (4) anti- retrovirals, (5) pathogen–drug mismatch, and (6) Staphylococcus aureus or yeast in blood culture. In addition, the EAM provides a list of patients with specific pathogens, such as multidrug- resistant organisms (MDRO) or organisms with elevated mini- mum inhibitory concentrations (MIC) to certain antibiotics (eg, Pseudomonas MIC 8≥µg/mL to cefepime). Interventions are documented by placing specific ‘i-vents’ in
the EMR associated with each antimicrobial order. These notes can be pulled into a report to enable the assessment of the specific number and types of interventions made during any period.
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