Table 2. Publications about Pharmacy Trainees’ Involvement in AS Efforts22-25 Study Settinga


Benson22 Long-term acute-care hospital


Level of Traineeb APPE student


AS Strategy/ Strategies Employed AS-Related Intervention Details


Prospective audit with intervention and feedback; dose optimization; streamlining/de-escalation of therapy


Laible et al23


Community teaching hospital (medical/ surgical ward)


Smith et al24


Academic medical center


PGY2 critical-care resident, PGY1 pharmacy resident, APPE student


PGY2 residents (critical care, oncology, pediatrics), PGY1 resident


Prospective audit with intervention and feedback; dose optimization; streamlining/de-escalation of therapy


Dose optimization; education


Students collected data on patients with an infection-related problem. Focus was on dose optimization, appropriate duration of therapy, drug allergy assessment, efficacy and toxicity monitoring, and adjustment of empirical therapy. Daily meetings with pharmacist, weekly meetings with ID physician.


Trainees collected data on all patients receiving antimicrobials. Focus was on dose optimization, drug changes, and discontinuation of therapy. Met 3 times per week with clinical pharmacist and ID physician.


Call schedule was once every 14 days, including overnight, on weekends, and on holidays for 24-h periods starting at 0800 each day. Focus was on pharmacokinetic monitoring of aminoglycosides and vancomycin, drug information consultation, assessing adverse drug events, screening for drug–drug interactions, and taking medication histories for HIV patients. Multiple clinical pharmacists were available for consultation by residents if needed.


Siegfried et al25


Academic medical center


PGY2 residents (infectious diseases and critical care)


Prospective audit with intervention and feedback; formulary restriction and preauthorization; dose optimization


Residents provided weekend coverage of AS program. Focus was on approval of restricted antimicrobial orders, prospectively auditing patients on restricted and broad- spectrum antibiotics at 72 h after treatment initiation, providing medication reconciliation for patients on antiretrovirals, advising on dosing of aminoglycosides and vancomycin, and reviewing all gram-positive bacteria blood cultures. ID-trained pharmacist available if needed.


Note. AS, antimicrobial stewardship; APPE, advanced pharmacy practice experience; ID, infectious diseases; PGY, postgraduate year. aAcademic medical center, community hospital, long-term care, etc. bStudent, resident, fellow.


Outcomes (If Applicable)


Antimicrobial daily expense decreased 14.9%, a cost savings of $261,630 for the 2-y period after implementation of the AS program.


554 recommendations were made; 68.4% were accepted in 2-y period.


863 activities were completed by the on-call residents with an average of 6.5 activities per day in a 6-mo period.


1,443 documented interventions in 1-y period. Compared to year before program implementation, antibiotic utilization decreased by 58.6 days of therapy/1,000 patient days, including decreases in the use of carbapenems, MRSA- active agents, and broad-spectrum antibiotics with antipseudomonal coverage. There was also a decrease in the Clostridium difficile infection rate.


Infection Control & Hospital Epidemiology


203


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