Remote Antimicrobial Stewardship: a Solution for Meeting the New Joint Commission Standard?

• Type of Material: Article
• Authors: Crystal Howell, Emory University; Roland Tam, Emory John’s Creek Hospital; David Lovell, Emory John’s Creek Hospital; Jesse Jacob, Emory University; Steve Mok, Emory University
• Language: English
• Date: 2017-10-04
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofx163.575
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 4
• Issue: suppl_1
• Start Page: S262
• End Page: S262
• Research Categories: Biology, Microbiology

Abstract

Background: The Joint Commission (TJC) now requires antimicrobial stewardship programs (ASP) at all hospitals starting January 1, 2017. The purpose of this study was to determine the time it takes to perform ASP activities at a small community hospital as well as barriers to remote stewardship. Methods: This was a prospective chart review and time study conducted in patients identified by a clinical decision support and electronic surveillance application as potential opportunities for antimicrobial therapy modification at Emory Johns Creek Hospital (EJCH), a suburban, 110-bed acute care hospital. The chart review was conducted remotely between December 12, 2016 and March 31, 2017 using predefined electronic alerts. These results were then communicated electronically to the EJCH pharmacists, who would communicate the recommendations to the patient’s provider. The primary endpoint was a time study for stewardship activities at a small community hospital. Secondary endpoints included describing barriers encountered to remote stewardship, and a cost-benefit analysis of remote stewardship at a small community hospital. Results: A total of 3,060 minutes were spent on ensuring regulatory compliance with 20.5% of that time spent reporting data on antimicrobial utilization. The time study also revealed an average of 11 alerts per day, 9 chart reviews per day, 8 interventions per day, and 5 minutes per chart. Seven hundred twenty-four alerts were evaluated with the most common alerts constituting opportunities for de-escalation (29%), targeted drugs (22%), positive blood cultures (18%), IV to PO (17%), and antimicrobial renal monitoring (8%). Interventions were accepted (11%), accepted modified (6%), rejected (35%), or undetermined (48%). Barriers to implementation included workflow and indirect communication. For patients with accepted interventions, there was an average of $279.82 per patient in savings of pharmacy charges. Conclusion: Remote stewardship is a feasible option for small community hospitals. In addition to the cost savings, this intervention appeared to positively impact quality and safety of care while providing compliance with the new TJC antimicrobial stewardship standard.