title: Implementation of a care bundle for antimicrobial stewardship.
abstract: OBJECTIVE
  The impact of an antibiotic-use care bundle on compliance with quality indicators was evaluated.
  
  
  METHODS
  Patients admitted to the internal medicine or surgery floor of a tertiary care center who were receiving an anti-pseudomonal beta-lactam, vancomycin, a fluoroquinolone, linezolid, an amino-glycoside, or any combination of these agents were included in the study. The study consisted of two phases: intervention (when a stewardship pharmacist was involved in patient care) and control (when no stewardship pharmacist was involved). The stewardship pharmacist completed interventions via prospective audit and suggested changes to empirical and definitive antimicrobials, monitored patients' cultures and antimicrobial therapy daily, and provided education on the institution's antibiogram. The primary outcome measured was compliance with the care bundle's quality indicators, which included documentation of treatment rationale, collection of appropriate culture specimens according to institutional and national guidelines, appropriate empirical selection of antibiotics according to institutional and national guidelines at initiation of antibiotic therapy and deescalation, and selection of appropriate agents for definitive therapy during antimicrobial therapy.
  
  
  RESULTS
  A total of 160 patients and 442 antibiotic orders were evaluated. During the intervention phase, 168 interventions were made, with an acceptance rate of 91%. The rate of appropriate deescalation rose from 72% to 90% (p = 0.01). Compliance with all quality indicators rose from 16% to 43% (p < 0.001).
  
  
  CONCLUSIONS
  Implementation of an antimicrobial stewardship program care bundle on two patient care units was associated with improved rates of compliance with quality indicators.
authors.affiliation: Henry Ford West Bloomfield Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Toth
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Chambers
authors.forename: Susan L
authors.initials: SL
authors.lastname: Davis
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008824:Michigan; D008875:Middle Aged; D010348:Patient Care Team; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D024382:Professional Role; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care
chemical_list: D000890:Anti-Infective Agents