title: Point-of-prescription interventions to improve antimicrobial stewardship.
abstract: Antimicrobial stewardship is pivotal to improving patient outcomes, reducing adverse events, decreasing healthcare costs, and preventing further emergence of antimicrobial resistance. In an era in which antimicrobial resistance is increasing, judicious antimicrobial use is the responsibility of every healthcare provider. Antimicrobial stewardship programs (ASPs) have made headway in improving antimicrobial prescribing using such "top-down" methods as formulary restriction and prospective audit with feedback; however, engagement of prescribers has not been fully explored. Strategies that include frontline prescribers and other unit-based healthcare providers have the potential to expand stewardship, both to augment existing centralized ASPs and to provide alternative approaches to perform stewardship at healthcare facilities with limited resources. This review discusses interventions focusing on antimicrobial prescribing at the point of prescription as well as a pilot project to engage unit-based healthcare providers in antimicrobial stewardship.
authors.affiliation: Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Keith W
authors.initials: KW
authors.lastname: Hamilton
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Division of Infectious Diseases, Duke University Medical Center Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Moehring
authors.affiliation: Division of Infectious Diseases, Duke University Medical Center Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina.
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Calderwood
authors.affiliation: Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Han
authors.affiliation: North American Medical Affairs, GlaxoSmithKline, Philadelphia, Pennsylvania.
authors.forename: Jimish M
authors.initials: JM
authors.lastname: Mehta
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Pollack
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Bernard C
authors.initials: BC
authors.lastname: Camins
authors.affiliation: Division of Infectious Diseases, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois.
authors.forename: David N
authors.initials: DN
authors.lastname: Schwartz
authors.affiliation: Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D003141:Communicable Diseases / Q000188:drug therapy* / Q000382:microbiology; D011307:Drug Prescriptions / Q000592:standards*; D018432:Drug Resistance, Multiple; D004363:Drug Utilization / Q000592:standards*; D006801:Humans
chemical_list: D000890:Anti-Infective Agents
keywords: antimicrobial prescribing; antimicrobial stewardship; frontline; point of prescription