Hospital Pharmacy - October 2017 - 628

726993
research-article2017

HPXXXX10.1177/0018578717726993Hospital PharmacyDubrovskaya et al

Article

Multilayer Model of Pharmacy
Participation in the Antimicrobial
Stewardship Program at a Large
Academic Medical Center

Hospital Pharmacy
2017, Vol. 52(9) 628-634
© The Author(s) 2017
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https://doi.org/10.1177/0018578717726993
DOI: 10.1177/0018578717726993
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Yanina Dubrovskaya1, Marco R. Scipione1,2, Justin Siegfried1,
Shin-Pung Jen1, Vinh Pham1, John Papadopoulos1,
Arnold Decano1,3, Tyler Lewis1, and Arash Dabestani1

Abstract
Purpose: Leveraging pharmacy personnel resources for the purpose of antimicrobial stewardship program (ASP) operations
presents a challenging task. We describe our experience integrating all pharmacists into an ASP, and evaluate the impact on
ASP interventions, antimicrobial utilization, rate of selected hospital-onset infections and readmission. Summary: During
a study period (January 1 to December 31, 2015), a total of 14 552 ASP-related pharmacy interventions were performed
(ASP clinical pharmacotherapy specialists [CPS] n = 4025; non-ASP CPS n = 4888; hospital pharmacists n = 5639). Sixty
percent of interventions by ASP CPS were initiated utilizing the dedicated ASP phone, and 40% through prospective
audit and feedback. Non-ASP CPS performed interventions during bedside rounds (dose adjustment 23%, initiate new or
alternative anti-infective 21%, discontinue antibiotic(s) 12%, therapeutic drug monitoring 11%, de-escalation 4%), whereas
hospital pharmacists participated at the point of verification (dose adjustment 75%, restricted antibiotic verification 15%,
and reporting major drug-drug interactions 4%). The acceptance rate of interventions by providers and clinicians was
>90% for all groups. Annual aggregate antimicrobial use decreased by 6.4 days of therapy/1000 patient-days (DOT/1000
PD; P = 1.0). Ceftriaxone use increased by 8.4 DOT/1000 PD (P = .029) without a significant compensatory increase in the
use of antipseudomonal agents. Sustained low rates of hospital-onset Clostridium difficile (CDI) and carbapenem-resistant
Enterobacteriaceae (CRE) infections were observed in 2015 compared with the prior year (1.1 and 1.2 cases/1000 PD, 0.2
and 0.1 cases/1000 PD, respectively). Thirty-day readmission rate decreased by 0.6% (P = .019). Conclusions: Integration
of all pharmacists into ASP activities based on the level of patient care and responsibilities is an effective strategy to expand
clinical services provided by ASP.
Keywords
antimicrobial stewardship program, interventions, antimicrobial utilization

Introduction
Antimicrobial stewardship programs (ASPs) have an essential role in improving patient outcomes, reducing antimicrobial adverse events, decreasing antimicrobial resistance, and
optimizing resource utilization.1-5 The Joint Commission
Antimicrobial Stewardship Standard for hospitals mandates
establishing an ASP as an organizational priority.6 Dedicated
medical and pharmacy staff with antimicrobial expertise are
critical for ASP success. It is recommended to identify an
ASP pharmacist co-leader to partner with a physician leader
or physician champion to provide the expertise and accountability needed for high-quality programs.6-9 An important
role of the ASP pharmacy co-leader is to engage and train

other pharmacy staff in appropriate antibiotic use, thereby
enhancing participation in ASP activities.7
In 2014, the Centers for Disease Control and Prevention
(CDC) published the "CDC Core Elements of Hospital
1

NYU Langone Health, New York, NY, USA
Memorial Sloan Kettering Cancer Center, New York, NY, USA
3
NYU Langone Hospital-Brooklyn, NY, USA
2

Corresponding Author:
Yanina Dubrovskaya, Pharmacy Clinical Manager, Infectious Diseases/
Antimicrobial Stewardship, Department of Pharmacy, NYU Langone
Health, 545 First Avenue, Greenberg Hall, SC2-097, New York,
NY 10016, USA.
Email: yanina.dubrovskaya@nyumc.org
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