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2015 ; 4
(Suppl 1
): 5-14
Nephropedia Template TP
gab.com Text
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English Wikipedia
Antimicrobial Stewardship with Pharmacist Intervention Improves Timeliness of
Antimicrobials Across Thirty-three Hospitals in South Africa
#MMPMID26362291
Messina AP
; van den Bergh D
; Goff DA
Infect Dis Ther
2015[Sep]; 4
(Suppl 1
): 5-14
PMID26362291
show ga
INTRODUCTION: Ensuring timely administration of antimicrobials is critical in the
management of patients with infections. Mortality increases by 7.6% for every
hour of delay in the administration of antimicrobial therapy in patients with
sepsis. The time elapsed from the written antibiotic order to actual intravenous
administration or 'hang-time' can often be several hours due to logistics within
the hospital. Our purpose is to evaluate the change in compliance with
administering antimicrobials within an hour of prescription after implementation
of a national antibiotic stewardship pharmacist-driven hang-time process
improvement protocol. METHODS: This was a prospective multicenter study in 33
South African hospitals from 1 July 2013-30 August 2014. Two pilot sites
established the mechanism for noninfectious disease pharmacists to make
interventions and document hang-time data. Following this, a hang-time compliance
assessment was initiated using the tools of healthcare improvement spread
methodology. This consisted of five stages and an implementation toolkit was
developed. The pharmacist study coordinator was responsible for implementation,
the development of an implementation toolkit and real-time coordination of data
with monthly feedback to all sites. RESULTS: A total of 32,985 patients who
received intravenous antibiotics were assessed for hang-time compliance with
first doses of new antibiotic orders. Over the 60-week period, 21,069 patients
received antibiotics within an hour following prescription and were assessed as
hang-time compliant. The change in improvement of hang-time compliance following
implementation of a pharmacist-driven hang-time process improvement protocol was
41.2% pre-intervention week 1 (164/398) to 78.4% post-intervention week 60
(480/612; P < 0.0001). Pharmacists reviewed and evaluated twice as many patients
during the final 4 weeks (1680) compared to the first 4 weeks (834; P < 0.0001).
CONCLUSION: Noninfectious disease pharmacists can significantly improve the
timely administration of antimicrobials and contribute to low-hanging-fruit
antimicrobial stewardship initiatives within a hospital system in a
resource-limited country.