#31 – “Mind the Gap”: Antimicrobial Stewardship at Transitions of Care

Antimicrobial stewardship is often an inpatient effort and overlooked at transitions of care. Dr. April Dyer (@aprildyerid) and Dr. Rachel Kenney (@rkenneypharmd) share insight with host Dr. David Ha (@DHpharmD) on current practice and barriers, and strategies for pharmacists to bring antimicrobial stewardship in the discharge process. 

Episode content:

00:14: Welcome and introductions:

04:39: Project overview: "Developing Patient Safety Outcome Measures and Measurement Tools for Antimicrobial Stewardship Program”

06:45: Scope of the problem (Scarpato et al.)

07:56: Michigan data (Vaughn et al.)

09:13: Building a business case

12:32: Where to Start?

12:54: Henry Ford Health System experience

15:18: IT solutions

17:22: 1% rule

20:26: Identifying and engaging key players

20:47: Outpatient pharmacy

22:29: Skilled nursing facilities

23:19: Case management relationship

24:23: Barriers to implementation

29:08: Quantifying total duration 

30:00: Identify electronic methods to capture total duration therapy attributable to hospitalization

32:16: CDC recommendation "Use the shortest effective antibiotic duration" 

33:16: Final remarks & acknowledgements

34:38: Outro

References:

Scarpato SJ, Timko DR, Cluzet VC, et al. An Evaluation of Antibiotic Prescribing Practices Upon Hospital Discharge. Infection Control and Hospital Epidemiology. 2017;38(3):353-355. doi:10.1017/ice.2016.276

Madaras-Kelly KJ, Burk M, Caplinger C, et al. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. Journal of Hospital Medicine. 2016;11(12):832-839. doi:10.1002/jhm.2648

Feller J, Lund BC, Perencevich EN, et al. Post-discharge oral antimicrobial use among hospitalized patients across an integrated national healthcare network. Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2020;26(3):327-332. doi:10.1016/j.cmi.2019.09.016

Daniels LM, Weber DJ. Interventions to improve antibiotic prescribing at hospital discharge: A systematic review. Infection Control and Hospital Epidemiology. Published online September 1, 2020:1-4. doi:10.1017/ice.2020.367

Vaughn VM, Gandhi TN, Chopra V, et al. Antibiotic Overuse after Hospital Discharge: A Multi-Hospital Cohort Study. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. Published online September 11, 2020. doi:10.1093/cid/ciaa1372

Dyer AP, Dodds Ashley E, Anderson DJ, et al. Total duration of antimicrobial therapy resulting from inpatient hospitalization. Infection Control and Hospital Epidemiology. 2019;40(8):847-854. doi:10.1017/ice.2019.118

Bianchini ML, Kenney RM, Lentz R, Zervos M, Malhotra M, Davis SL. Discharge Delays and Costs Associated with Outpatient Parenteral Antimicrobial Therapy for High priced Antibiotics. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. Published online October 31, 2019. doi:10.1093/cid/ciz1076

Disclosures

Dr. April Dyer and Rachel Kenney report no relevant financial disclosures. SIDP reports no relevant financial disclosures. 

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