Integrate & Operationalize Guidelines-References

References

• Ciarkowski CE, et al. A Pathway for Community-Acquired Pneumonia with Rapid Conversion to Oral Therapy Improves Health Care Value. Open Forum Infect Dis 2020.
• This study noted a shorter length of IV antibiotic therapy when a clinical decision support-driven CAP pathway was implemented, along with active antimicrobial stewardship review.
• Haas MK, et al. Effects of a Syndrome-Specific Antibiotic Stewardship Intervention for Inpatient Community-Acquired Pneumonia. Open Forum Infect Dis 2016.
  • Reduced duration of CAP treatment by development of institutional guidelines and integration into CPOE for treatment of non-ICU CAP using key stakeholders and hospitalist physician champions
  • For education/dissemination: utilized emails, posters in work rooms, presentations in Grand Rounds and division meetings
• Hartley S, et al. Evaluating a Hospitalist-Based Intervention to Decrease Unnecessary Antimicrobial Use in Patients With Asymptomatic Bacteriuria. Infect Control Hosp Epidemiol 2016.
  • Reduced treatment of ASB with educational sessions and pocket cards for hospitalists at all sites, and a pharmacist-led review of positive urine cultures at one site
• Meeker D, et al. Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial. JAMA Intern Med 2014.
• Displayed poster-sized commitment letters to avoid inappropriate antibiotic prescribing for Acute Respiratory Infections (ARIs) in exam rooms, providing patient/family education and behavioral “nudge”

• Mercuro N, et al. Pharmacist-Driven Transitions of Care Practice Model for Prescribing Oral Antimicrobials at Hospital Discharge. JAMA Netw Open 2022.
• A pharmacist-driven intervention targeting antimicrobial prescribing at discharge was associated with higher frequency of optimal antimicrobial regimens compared with before the intervention. Patients in the postintervention group had similar rates of mortality, readmission, and clinical resolution and fewer severe antimicrobial-related adverse effects compared with the preintervention group.
• Scymzcak J, et al. Pediatrician Perceptions of an Outpatient Antimicrobial Stewardship Intervention. Infect Control Hosp Epidemiol 2014.
• Qualitative study interviewing pediatricians after a stewardship intervention
• Found skepticism of accuracy of audit and feedback reports
• Vaughn V, et al. Thoughtless design of the electronic health record drives overuse, but purposeful design can nudge improved patient care. BMJ Qual & Saf 2018.
• A critical step in improving clinician behavior is recognizing that most decisions occur with little active deliberation. When making rapid choices, clinicians are being influenced by EHR design, defaults, diagnostic stimuli, emotion, and social norms - whether purposeful or not. To improve, we must recognize these tendencies and use thoughtful design to capitalize on the potential of the EHR to improve patient care.
• Vaughn V, et al. Antibiotic Overuse at Discharge in Hospitalized Patients with Bacteriuria or Treated for Pneumonia: A Multihospital Study. Infect Con Hosp Epi 2020.
• Antibiotic overuse at discharge is common, varies widely between hospitals, and is associated with patient harm. Antibiotic overuse at discharge is strongly correlated between two disparate diseases, suggesting that prescribing culture or discharge processes contribute to overprescribing.
• Vaughn V, et al. Antibiotic Overuse and Stewardship at Hospital Discharge: A Multi-Hospital Cohort Study. Clin Inf Dis 2021.
• Antibiotics are commonly prescribed to patients as they leave the hospital. The aim was to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection.

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