S1. Antimicrobial Stewardship program development and implementation
Oral Abstract Submission
Philip Chung, PharmD, MS, BCPS, BCIDP
Community Network Pharmacy Coordinator for Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP)
Nebraska Medicine
Omaha, NE
Disclosure: Nothing to disclose
Regina Nailon, PhD, RN
Clinical Nurse Researcher
Nebraska Medicine
Omaha, NE
Disclosure: Nothing to disclose
M. Salman Ashraf, MBBS
Associate Professor, Division of Infectious Diseases
University of Nebraska Medical Center
Omaha, NE
Disclosure: Merck& Co. Inc: Research Grant or Support
Scott Bergman, PharmD, FCCP, FIDSA, BCPS
Pharmacist- Antimicrobial Stewardship Coordinator
Nebraska Medicine
Omaha, Nebraska
Disclosure: Nothing to disclose
Teresa Micheels, MSN, RN, CIC
Infection Control Manager
Nebraska Medicine
Omaha, NE
Disclosure: Nothing to disclose
Mark E. Rupp, MD
Professor and Chief, Division of Infectious Diseases
University of Nebraska Medical Center
Omaha, Nebraska
Disclosure: Nothing to disclose
Michelle Schwedhelm, MSN, RN, NEA-BC
Executive Director, Emergency Management & Biopreparedness
Nebraska Medicine
Omaha, NE
Disclosure: Nothing to disclose
Maureen Tierney, MD, MSc
Health Care Associated Infections Director
Nebraska Department of Health and Human Services
Omaha, NE
Disclosure: Nothing to disclose
Kate Tyner, BSN, RN, CIC
Infection Preventionist for Nebraska ASAP
Nebraska Medicine
Omaha, NE
Disclosure: Nothing to disclose
Trevor C. Van Schooneveld, MD, FACP
Associate Professor, Division of Infectious Diseases
University of Nebraska Medical Center
Omaha, Nebraska
Disclosure: BioFire: Consultant
Insmed: Consultant
Merck: Research Grant
Rebiotix: Research Grant
Jasmine R. Marcelin, MD
Assistant Professor, Division of Infectious Diseases
University of Nebraska Medical Center
Omaha, Nebraska
Disclosure: Nothing to disclose
Background : Nebraska (NE) ranks among the highest states for per capita antibiotic (AB) use in outpatient (OP) settings. Nebraska Medicine (NM) partnered with NE Antimicrobial Stewardship Assessment and Promotion Program (ASAP), a program funded by NE DHHS via a CDC grant, to reduce AB prescribing for acute bronchitis in OP settings.
Methods : The antimicrobial stewardship (AS) pilot program targeted NM OP clinics during winter 2018. All OP facility clinicians were notified of the availability of online AS educational videos. In addition, 5 primary care clinics (PCC) received clinician-directed interventions that included acute respiratory infection management pocket guides and posters for display in workrooms. Another 5 PCC received both clinician- and patient-directed interventions (exam room patient empowerment posters, Be Antibiotic Aware pledge cards and brochures). We compared AB prescribing rates for acute bronchitis between January-April 2017 and January-April 2018 among the 2 PCC groups and a control group of 5 immediate care clinics/emergency departments (ICC/ED). Clinicians in all 10 PCC were surveyed to assess usefulness of the AS campaign.
Results : A total of 593 acute bronchitis diagnosis encounters were included. AB prescribing rates for acute bronchitis for the 15 sites decreased from 53.7% to 43.6% (p = 0.02). Prescribing rates were unchanged in ICC/ED that received only notification of online educational videos (40.8% vs. 41.5%, p = 1.00) but were reduced in clinics that received clinician-directed (74.5% vs. 33.3%, p < 0.01) and patient-directed (61.1% vs. 48.8%, p = 0.07) interventions. Azithromycin was the most commonly prescribed AB (31.5% in 2017 and 29.8% in 2018). After the AS campaign, only the clinician-directed intervention group saw a reduction in azithromycin prescribing (33.3% vs. 13.9%, p < 0.05). Out of 51 clinicians who completed the survey, 45.1% felt campaign tools facilitated meaningful discussion with patients. Workroom posters and pocket guides were reported by 47.1% and 39.2% to be somewhat or extremely helpful, respectively
Conclusion : This OP AS campaign led to a significant reduction in AB prescribing. Successful OP AS campaigns need multifaceted approaches but targeted clinician interventions appear most beneficial.