title: Antimicrobial stewardship and automated pharmacy technology improve antibiotic appropriateness for community-acquired pneumonia.
abstract: BACKGROUND
  The Centers for Medicare and Medicaid Services' (CMS's) Hospital Inpatient Quality Reporting program includes the initial selection of antibiotics for adult community-acquired pneumonia (CAP) patients as a performance measure. A multidisciplinary team defined opportunities for improving performance in appropriate antibiotic use among CAP patients. The team consisted of personnel from the emergency department (ED), the antimicrobial stewardship program (infectious disease, pharmacy), and performance improvement.
  
  
  METHODS
  Quasi-experimental before-after study.
  
  
  METHODS
  A large, urban, multicampus academic medical center. Interventions. Interventions included an algorithm for ED providers identifying appropriate antibiotic selections, development of a CAP kit consisting of appropriate antibiotics and dosing regimens bundled with the treatment algorithm, and preloading an automated ED medication dispensing and management system. A quality improvement methodology ("plan, do, check, act") was used to pilot stewardship interventions at one ED campus and later at a second ED campus.
  
  
  RESULTS
  In the pilot ED, appropriate antibiotic selection for CAP improved from 54.9% before the intervention in 2008 to 93.4% after the intervention in 2011 (P = .001). Subsequently, in the second ED appropriate antibiotic regimens for CAP improved from 64.6% before the intervention in 2008 to 91.3% after the intervention in 2011 (P = .004)). The rates of another CMS measure, antibiotic administration within 6 hours, were not statistically different before and after the interventions. In an interrupted time series logistic regression analysis, the intervention was found to be significantly associated with the improved prescribing ([Formula: see text]).
  
  
  CONCLUSIONS
  The combination of interdisciplinary teamwork, antibiotic stewardship, education, and information technology is associated with replicable and sustained prescribing improvements.
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA. bostrows@montefiore.org
authors: Belinda
authors: B
authors: Ostrowsky
authors: Shweta
authors: S
authors: Sharma
authors: Maryrose
authors: M
authors: DeFino
authors: Yi
authors: Y
authors: Guo
authors: Purvi
authors: P
authors: Shah
authors: Susan
authors: S
authors: McAllen
authors: Philip
authors: P
authors: Chung
authors: Shakara
authors: S
authors: Brown
authors: Joseph
authors: J
authors: Paternoster
authors: Alan
authors: A
authors: Schechter
authors: Brandon
authors: B
authors: Yongue
authors: Rohit
authors: R
authors: Bhalla
mesh_terms: D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004636:Emergency Service, Hospital; D019983:Guideline Adherence; D006786:Hospitals, Urban; D006801:Humans; D033183:Interdisciplinary Communication; D008510:Medication Systems, Hospital; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement
chemical_list: D000900:Anti-Bacterial Agents