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2018 ; 16
(2
): 855
Nephropedia Template TP
gab.com Text
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English Wikipedia
Impact of printed antimicrobial stewardship recommendations on early intravenous
to oral antibiotics switch practice in district hospitals
#MMPMID30023021
Sze WT
; Kong MC
Pharm Pract (Granada)
2018[Apr]; 16
(2
): 855
PMID30023021
show ga
BACKGROUND: Early intravenous to oral (IV-PO) antibiotics switch, which is one of
the important elements in antimicrobial stewardship (AMS) is not well implemented
in Malaysian district hospitals. A systematic interventional strategy is required
to facilitate IV-PO antibiotic switch. OBJECTIVE: This study aimed to evaluate
the impact of printed AMS recommendations on early IV-PO antibiotics switch
practice in district hospitals. METHODS: This study was an interventional study
conducted in medical wards of eight Sarawak district hospitals from May to August
2015. In pre-intervention phase, pharmacists performed the conventional practice
of reviewing medication charts and verbally informed the prescribers on eligible
IV-PO switches. In post-intervention phase, pharmacists attached printed
checklist which contained IV-PO switch criteria to patients' medical notes on the
day patients were eligible for the switch. Stickers of IV-PO switch were applied
to the antibiotic prescription to serve as reminders. RESULTS: 79 and 77 courses
of antibiotics were studied in the pre-intervention phase and post-intervention
phase respectively. Timeliness of switch was improved by 1.63 days in the
post-intervention phase (95%CI 1.26:2.00 days, p<0.001). Mean duration of IV
antibiotics in the post-intervention phase was shorter than pre-intervention
phase (2.81 days (SD=1.77) vs 4.05 days (SD=2.81), p<0.001). The proportion of
IV-PO switches that were only performed upon discharge reduced significantly in
the post-intervention phase (31.2% vs 82.3%, p<0.001). Length of hospital stay in
the post-intervention phase was shortened by 1.44 days (p<0.001). Median
antibiotic cost savings increased significantly in the post-intervention phase
compared to the pre-intervention phase [MYR21.96 (IQR=23.23) vs MYR13.10
(IQR=53.76); p=0.025)]. CONCLUSIONS: Pharmacist initiated printed AMS
recommendations are successful in improving the timeliness of IV-PO switch,
reducing the duration of IV, reducing the length of hospitalisation, and
increasing antibiotic cost savings.