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Clinicians shared positive opinion of antimicrobial stewardship program, benefited prescribing behaviors
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Interventions implemented through antimicrobial stewardship programs were well received by practitioners and resulted in reduced rates of inappropriate antibiotic use in a Delaware health care system, according to recent study findings published in Clinical Pediatrics.
“Clinicians and hospitals that are considering developing an [antimicrobial stewardship program (ASP)] can anticipate that comprehensive ASP interventions will likely be well received and can likely affect prescribing behaviors in a positive way,” the researchers wrote. “They should also expand awareness of the program strategies and its interventions within their clinical setting.”
Dustin D. Flannery, DO, of Alfred I DuPont Hospital for Children, and colleagues surveyed providers following implementation of an ASP in 2004 to determine the effect of implementation. Ninety-three participants were chosen based on frequency of prescriptions for antimicrobial medications.
Dustin D. Flannery
The highest response rates were from hospitalists (91%) followed by resident physicians (67%), advanced practitioner nurses/physicians assistants (67%), PEM attendings (41%), and pediatric fellows (38%). [DF1] Thirty-two percent of participants reported accessing the supplemental online resources more than once per month and 27% reported they were not familiar with the program. Eighty-two percent of participants said recommendations from ID pharmacists were found to be more than somewhat helpful. All aspects of the ASP were found to be more than somewhat helpful by more than sixty percent of participants.
Never having a patient report an adverse outcome related to the ASP was reported by 94% of participants. Seventy-six percent of participants reported they never received advice regarding antimicrobials that turned out to be wrong. Falsifying infectious disease physician approval for restricted antimicrobials was never done by 93% of participants and falsifying antimicrobial indication was never done by 65%. Residents were more likely to access the ASP online resources compared with nonresidents (P=.0001). Familiarity with the infectious disease pharmacist was more likely among residents (P=.0014) as well as finding the vancomycin order set more helpful (P=.0012).
“The results suggest that some practitioners were not as familiar with the program and its interventions as we had expected,” the researchers wrote. “Many respondents, primarily nonresidents, were less likely to utilize supplemental online resources. In light of this feedback, we are working on making practitioners more aware of this aspect of the program and making its features more user-friendly and transparent. Our survey specifically addressed ASP interventions at our own institution and may not be applicable to other programs, especially those without electronic medical records and [computerized provider order entry]. Finally, our survey has not been validated, and therefore, there is potential for random and measurement error, which are innate to a survey-type study.”
Dustin D. Flannery, DO, can be reached at vtdus10@gmail.com.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Jason G. Newland, MD
The increase in antibiotic resistant bacteria combined with the limited number of new antibiotics being developed have made it imperative that the use of antibiotics are monitored or stewarded. Antimicrobial stewardship programs (ASP) are a key part of managing antimicrobial use and limiting the resistance pressure on bacteria while assuring the best treatment for patients. In order for ASPs be effective, the clinicians must be engaged and supportive of the program.
Flannery and colleagues have recently published a manuscript that surveyed their clinicians at DuPont Children’s Hospital on how well their stewardship program is performing (Clin Pediatr. 2014:doi:10.1177/0009922814528279). They demonstrated that a majority of the prescribers regarded ASP recommendations as helpful. Stach and colleagues also found the same sentiment among their prescribers and furthermore their prescribers believed their ASP improved the quality of patient care (J Pediatr Infect Dis Soc. 2012;1:190-197).
An interesting finding from this study was the assessment of the providers’ impression of the ASP making wrong recommendations and whether an ASP recommendation led to an adverse outcome. Three-quarters of the respondents reported the ASP never giving a wrong recommendation and 94% reported never having a patient experience an adverse outcome. These findings are important as the providers being impacted by the ASP trust in their program.
Antimicrobial stewardship programs are an essential part of our healthcare system. While it has been demonstrated that a major perceived barrier to developing an ASP has been the loss of autonomy that prescribers will feel, this study further demonstrates the positive impression that clinicians have regarding these programs. Additional data is needed from those involved with ASPs to further demonstrate that these programs improve the outcomes of our patients.
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