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KMID : 0869620180350010030
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Journal of Korean Society of Hospital Pharmacists
2018 Volume.35 No. 1 p.30 ~ p.38
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Implementation and Expectation of Pharmacist-Enhanced Antimicrobial Stewardship Program in Korea
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Kim Hyung-Sook
Kim Song-Yi
Lee Eun-Sook
Lee Euni
Song Kyoung-Ho
Kim Eu-Suk
Kim Hong-Bin
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Abstract
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Background : Pharmacists are key members of the Antimicrobial Stewardship Program (ASP) team playing a critical role in improving antimicrobial use. A pharmacy intervention program built in the hospital electronic medical records for ASP (ASP-EMR) was developed and the sustained impact of the pharmacist-enhanced ASP was described in this study as measured by antimicrobial use and costs and the proportion of inappropriate antimicrobial prescriptions.
Methods : An interrupted time series with segmented regression analysis was conducted in 3 stages; 1-preintervention; 2-pharmacists’participation in ASP without ASP-EMR and 3-pharmacists’ participation in ASP with ASP-EMR. Using EMR data from a tertiary care hospital, the information on the prescribed antimicrobial agents was extracted 2009-2016. The pharmacist-enhanced ASP intervention started in March 2012. Prospective audit and feedback were triggered by ASP-EMR and the program was led by 1 clinical pharmacist and 1 pharmacy resident. Changes in the outcomes were compared before and after the pharmacist intervention with or without ASP-EMR.
Results : The development of pharmacy intervention program via ASP-EMR was completed in May 2016. After the pharmacist-enhanced ASP intervention, the rate of broad spectrum antimicrobial agents decreased as measured by daily defined doses (DDDs)/1,000 inpatient days (120.1 in Stage 1 and 103.5 in stage 3). In Stage 3, inappropriate duplication of anaerobic coverage was decreased as compared to Stage 1 as measure by days of therapy (DOT)/length of therapy (LOT) (1.13 in Stage 1 and 1.01 in Stage 3). The intervention on the intravenous (IV)-to oral conversion of quinolones increased the proportion of oral ciprofloxacin prescription and the estimated cost avoidance from interventions was 4,291,797 won in Stage 2 and 5,208,979 won in Stage 3.
Conclusion : The implementation of the pharmacists’participation in ASP at a tertiary care hospital in Korea was associated with a positive impact on antimicrobial use, spending, and inappropriate prescriptions.
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KEYWORD
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Antimicrobial stewardship program, Intervention, Antimicrobial agents
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