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The effectiveness of Check of Medication Appropriateness for antimicrobial stewardship: an interrupted time series analysis

The effectiveness of Check of Medication Appropriateness for antimicrobial stewardship: an... ObjectivesInappropriate prescribing of antimicrobials in hospitals contributes to the emergence of resistance and adverse drug events. To support antimicrobial stewardship (AMS), clinical decision rules focusing on antimicrobial therapy were implemented in the ‘Check of Medication Appropriateness’ (CMA). The CMA is a hospital-wide pharmacist-led medication review service consisting of a clinical rule-based screening for potentially inappropriate prescriptions (PIPs). We aimed to investigate the impact of the CMA on antimicrobial prescribing.MethodsAn interrupted time series study was performed at the University Hospitals Leuven. The pre-implementation cohort was exposed to standard-of-care AMS. Afterwards, an AMS-focused CMA comprising 41 specific clinical rules, targeting six AMS objectives, was implemented in the post-implementation period. A regression model was used to assess the impact of the intervention on the number of AMS-related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the 2 year post-implementation period.ResultsPre-implementation, a median proportion of 75% (range: 33%–100%) residual PIPs per day was observed. After the CMA intervention, the proportion was reduced to 8% (range: 0%–33%) per day. Use of clinical rules resulted in an immediate relative reduction of 86.70% (P < 0.0001) in AMS-related residual PIPs. No significant underlying time trends were observed during the study period. Post-implementation, 2790 recommendations were provided of which 81.32% were accepted.ConclusionsWe proved that the CMA approach reduced the number of AMS-related residual PIPs in a highly significant and sustained manner, with the potential to further expand the service to other AMS objectives. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Antimicrobial Chemotherapy Oxford University Press

The effectiveness of Check of Medication Appropriateness for antimicrobial stewardship: an interrupted time series analysis

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References (30)

Publisher
Oxford University Press
Copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.
ISSN
0305-7453
eISSN
1460-2091
DOI
10.1093/jac/dkab364
Publisher site
See Article on Publisher Site

Abstract

ObjectivesInappropriate prescribing of antimicrobials in hospitals contributes to the emergence of resistance and adverse drug events. To support antimicrobial stewardship (AMS), clinical decision rules focusing on antimicrobial therapy were implemented in the ‘Check of Medication Appropriateness’ (CMA). The CMA is a hospital-wide pharmacist-led medication review service consisting of a clinical rule-based screening for potentially inappropriate prescriptions (PIPs). We aimed to investigate the impact of the CMA on antimicrobial prescribing.MethodsAn interrupted time series study was performed at the University Hospitals Leuven. The pre-implementation cohort was exposed to standard-of-care AMS. Afterwards, an AMS-focused CMA comprising 41 specific clinical rules, targeting six AMS objectives, was implemented in the post-implementation period. A regression model was used to assess the impact of the intervention on the number of AMS-related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the 2 year post-implementation period.ResultsPre-implementation, a median proportion of 75% (range: 33%–100%) residual PIPs per day was observed. After the CMA intervention, the proportion was reduced to 8% (range: 0%–33%) per day. Use of clinical rules resulted in an immediate relative reduction of 86.70% (P < 0.0001) in AMS-related residual PIPs. No significant underlying time trends were observed during the study period. Post-implementation, 2790 recommendations were provided of which 81.32% were accepted.ConclusionsWe proved that the CMA approach reduced the number of AMS-related residual PIPs in a highly significant and sustained manner, with the potential to further expand the service to other AMS objectives.

Journal

Journal of Antimicrobial ChemotherapyOxford University Press

Published: Oct 7, 2021

Keywords: hospitals, university; pharmacists; antimicrobials; appropriateness; prescribing behavior; antimicrobial stewardship; medication review; prognosis in palliative care study; preschool imitation and praxis scale; interrupted time series analysis; standard of care; adverse effects of medication; inappropriate drug prescribing; clinical decision rules

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