title: Evaluating the impact of a pharmacist's absence from an antimicrobial stewardship team.
abstract: OBJECTIVE
  Results of a study to determine the impact of a clinical pharmacist's temporary absence from a hospital's antimicrobial stewardship team are presented.
  
  
  METHODS
  A retrospective chart review was conducted to compare the appropriateness of the use of selected antimicrobial medications with and without regular pharmacist involvement on the hospital's antimicrobial stewardship team. The charts of two samples of patients were evaluated: (1) 119 patients who had received prolonged (≥72 hours) imipenem-cilastatin, linezolid, or micafungin therapy over a three-month period during which a clinical pharmacist routinely provided interventions to help ensure the drugs were used according to institutional guidelines and (2) 111 patients treated with one of the three drugs during a three-month period when the clinical pharmacist did not serve on the stewardship team.
  
  
  RESULTS
  Relative to the period of active pharmacist involvement in antimicrobial stewardship, rates of inappropriate use of imipenem-cilastatin, linezolid, and micafungin during the pharmacist's absence were deemed to have increased by 27, 39, and 35 percentage points, respectively, with corresponding increases in the average duration of therapy of 0.7, 4.0, and 3.2 days; in addition, the number of cases of Clostridium difficile infection increased more than threefold (from 8 to 25) during the pharmacist's absence.
  
  
  CONCLUSIONS
  The temporary absence of a pharmacist from the antimicrobial stewardship team was associated with increased rates of inappropriate use of restricted antimicrobial agents and consequent increases in average durations of therapy.
authors.affiliation: College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43614, USA. diane.cappelletty@utoledo.edu
authors.forename: Diane
authors.initials: D
authors.lastname: Cappelletty
authors.forename: David
authors.initials: D
authors.lastname: Jacobs
mesh_terms: D000081:Acetamides / Q000592:standards / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000592:standards / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000592:standards / Q000627:therapeutic use; D015377:Cilastatin / Q000592:standards / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D004338:Drug Combinations; D004352:Drug Resistance, Microbial / Q000187:drug effects; D054714:Echinocandins / Q000592:standards / Q000627:therapeutic use; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D015378:Imipenem / Q000592:standards / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D000069349:Linezolid; D055666:Lipopeptides / Q000592:standards / Q000627:therapeutic use; D008508:Medication Errors / Q000706:statistics & numerical data*; D054539:Medication Therapy Management / Q000458:organization & administration* / Q000592:standards; D000077551:Micafungin; D009820:Ohio; D023303:Oxazolidinones / Q000592:standards / Q000627:therapeutic use; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D010607:Pharmacy Service, Hospital / Q000458:organization & administration* / Q000592:standards; D012189:Retrospective Studies; D000078329:Workforce
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D004338:Drug Combinations; D054714:Echinocandins; D055666:Lipopeptides; D023303:Oxazolidinones; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; D000069349:Linezolid; D000077551:Micafungin