#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:

1. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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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