title: Evaluation of pharmacy generalists performing antimicrobial stewardship services.
abstract: OBJECTIVE
  Improvements in medication use achieved by pharmacy generalists using a care bundle approach to antimicrobial stewardship are reported.
  
  
  METHODS
  A six-month prospective, repeated-treatment, quasi-experimental study involving three month-long intervention periods and three month-long control periods was conducted in the setting of an existing antimicrobial stewardship program at a large hospital. The intervention involved prospective audit and feedback conducted by pharmacy generalists who were trained in an antimicrobial stewardship care bundle approach. During control months, a pharmacy generalist who was not trained in antimicrobial stewardship rounded with the multidisciplinary team and provided standard-of-care pharmacy services. The primary endpoint was compliance with a care bundle of four antimicrobial stewardship metrics: documentation of indication for therapy in the medical record, selection of empirical therapy according to institutional guidelines, documented performance of indicated culture testing, and deescalation of therapy when indicated.
  
  
  RESULTS
  Two-hundred eighty-six patients were enrolled in the study: 124 in the intervention group and 162 in the control group. The cumulative rate of full compliance with all care bundle components during the six-month study was significantly greater during intervention months than during control months (68.5% versus 45.7%, p < 0.001). After adjusting for infection type, antimicrobial stewardship provided by an intervention-group pharmacist was associated with improved care bundle compliance (adjusted odds ratio, 2.70; p < 0.001). No significant differences in patient outcomes during intervention and control months were detected.
  
  
  CONCLUSIONS
  Pharmacy generalists trained to comply with a systematic care bundle approach enhanced the quality of antimicrobial management.
authors.affiliation: Joseph J. Carreno, Pharm.D., is Assistant Professor, Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Rachel M. Kenney, Pharm.D., BCPS, AQ-ID, is Pharmacy Specialist, Antimicrobial Stewardship; Mary Bloome, B.S.Pharm., is Clinical Pharmacist; and Jane McDonnell, Pharm.D., is Clinical Pharmacist, Henry Ford Hospital, Detroit, MI. Jennifer Rodriguez, Pharm.D., BCPS, is Clinical Pharmacist, Henry Ford Hospital, and Inpatient Pharmacy Manager, St. Joseph Mercy Chelsea, Chelsea, MI. Allison Weinmann, M.B.B.S., FRACP, is Senior Staff, Infectious Diseases Division, Henry Ford Hospital, and Clinical Assistant Professor, Wayne State University School of Medicine, Detroit. Paul E. Kilgore, M.P.H., M.D., is Associate Professor and Director of Research, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. Susan L. Davis, Pharm.D., is Infectious Diseases Pharmacy Specialist, Henry Ford Hospital, and Clinical Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Carreno
authors.affiliation: Joseph J. Carreno, Pharm.D., is Assistant Professor, Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Rachel M. Kenney, Pharm.D., BCPS, AQ-ID, is Pharmacy Specialist, Antimicrobial Stewardship; Mary Bloome, B.S.Pharm., is Clinical Pharmacist; and Jane McDonnell, Pharm.D., is Clinical Pharmacist, Henry Ford Hospital, Detroit, MI. Jennifer Rodriguez, Pharm.D., BCPS, is Clinical Pharmacist, Henry Ford Hospital, and Inpatient Pharmacy Manager, St. Joseph Mercy Chelsea, Chelsea, MI. Allison Weinmann, M.B.B.S., FRACP, is Senior Staff, Infectious Diseases Division, Henry Ford Hospital, and Clinical Assistant Professor, Wayne State University School of Medicine, Detroit. Paul E. Kilgore, M.P.H., M.D., is Associate Professor and Director of Research, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. Susan L. Davis, Pharm.D., is Infectious Diseases Pharmacy Specialist, Henry Ford Hospital, and Clinical Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Kenney
authors.affiliation: Joseph J. Carreno, Pharm.D., is Assistant Professor, Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Rachel M. Kenney, Pharm.D., BCPS, AQ-ID, is Pharmacy Specialist, Antimicrobial Stewardship; Mary Bloome, B.S.Pharm., is Clinical Pharmacist; and Jane McDonnell, Pharm.D., is Clinical Pharmacist, Henry Ford Hospital, Detroit, MI. Jennifer Rodriguez, Pharm.D., BCPS, is Clinical Pharmacist, Henry Ford Hospital, and Inpatient Pharmacy Manager, St. Joseph Mercy Chelsea, Chelsea, MI. Allison Weinmann, M.B.B.S., FRACP, is Senior Staff, Infectious Diseases Division, Henry Ford Hospital, and Clinical Assistant Professor, Wayne State University School of Medicine, Detroit. Paul E. Kilgore, M.P.H., M.D., is Associate Professor and Director of Research, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. Susan L. Davis, Pharm.D., is Infectious Diseases Pharmacy Specialist, Henry Ford Hospital, and Clinical Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
authors.forename: Mary
authors.initials: M
authors.lastname: Bloome
authors.affiliation: Joseph J. Carreno, Pharm.D., is Assistant Professor, Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Rachel M. Kenney, Pharm.D., BCPS, AQ-ID, is Pharmacy Specialist, Antimicrobial Stewardship; Mary Bloome, B.S.Pharm., is Clinical Pharmacist; and Jane McDonnell, Pharm.D., is Clinical Pharmacist, Henry Ford Hospital, Detroit, MI. Jennifer Rodriguez, Pharm.D., BCPS, is Clinical Pharmacist, Henry Ford Hospital, and Inpatient Pharmacy Manager, St. Joseph Mercy Chelsea, Chelsea, MI. Allison Weinmann, M.B.B.S., FRACP, is Senior Staff, Infectious Diseases Division, Henry Ford Hospital, and Clinical Assistant Professor, Wayne State University School of Medicine, Detroit. Paul E. Kilgore, M.P.H., M.D., is Associate Professor and Director of Research, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. Susan L. Davis, Pharm.D., is Infectious Diseases Pharmacy Specialist, Henry Ford Hospital, and Clinical Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
authors.forename: Jane
authors.initials: J
authors.lastname: McDonnell
authors.affiliation: Joseph J. Carreno, Pharm.D., is Assistant Professor, Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Rachel M. Kenney, Pharm.D., BCPS, AQ-ID, is Pharmacy Specialist, Antimicrobial Stewardship; Mary Bloome, B.S.Pharm., is Clinical Pharmacist; and Jane McDonnell, Pharm.D., is Clinical Pharmacist, Henry Ford Hospital, Detroit, MI. Jennifer Rodriguez, Pharm.D., BCPS, is Clinical Pharmacist, Henry Ford Hospital, and Inpatient Pharmacy Manager, St. Joseph Mercy Chelsea, Chelsea, MI. Allison Weinmann, M.B.B.S., FRACP, is Senior Staff, Infectious Diseases Division, Henry Ford Hospital, and Clinical Assistant Professor, Wayne State University School of Medicine, Detroit. Paul E. Kilgore, M.P.H., M.D., is Associate Professor and Director of Research, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. Susan L. Davis, Pharm.D., is Infectious Diseases Pharmacy Specialist, Henry Ford Hospital, and Clinical Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rodriguez
authors.affiliation: Joseph J. Carreno, Pharm.D., is Assistant Professor, Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Rachel M. Kenney, Pharm.D., BCPS, AQ-ID, is Pharmacy Specialist, Antimicrobial Stewardship; Mary Bloome, B.S.Pharm., is Clinical Pharmacist; and Jane McDonnell, Pharm.D., is Clinical Pharmacist, Henry Ford Hospital, Detroit, MI. Jennifer Rodriguez, Pharm.D., BCPS, is Clinical Pharmacist, Henry Ford Hospital, and Inpatient Pharmacy Manager, St. Joseph Mercy Chelsea, Chelsea, MI. Allison Weinmann, M.B.B.S., FRACP, is Senior Staff, Infectious Diseases Division, Henry Ford Hospital, and Clinical Assistant Professor, Wayne State University School of Medicine, Detroit. Paul E. Kilgore, M.P.H., M.D., is Associate Professor and Director of Research, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. Susan L. Davis, Pharm.D., is Infectious Diseases Pharmacy Specialist, Henry Ford Hospital, and Clinical Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
authors.forename: Allison
authors.initials: A
authors.lastname: Weinmann
authors.affiliation: Joseph J. Carreno, Pharm.D., is Assistant Professor, Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Rachel M. Kenney, Pharm.D., BCPS, AQ-ID, is Pharmacy Specialist, Antimicrobial Stewardship; Mary Bloome, B.S.Pharm., is Clinical Pharmacist; and Jane McDonnell, Pharm.D., is Clinical Pharmacist, Henry Ford Hospital, Detroit, MI. Jennifer Rodriguez, Pharm.D., BCPS, is Clinical Pharmacist, Henry Ford Hospital, and Inpatient Pharmacy Manager, St. Joseph Mercy Chelsea, Chelsea, MI. Allison Weinmann, M.B.B.S., FRACP, is Senior Staff, Infectious Diseases Division, Henry Ford Hospital, and Clinical Assistant Professor, Wayne State University School of Medicine, Detroit. Paul E. Kilgore, M.P.H., M.D., is Associate Professor and Director of Research, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. Susan L. Davis, Pharm.D., is Infectious Diseases Pharmacy Specialist, Henry Ford Hospital, and Clinical Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Kilgore
authors.affiliation: Joseph J. Carreno, Pharm.D., is Assistant Professor, Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Rachel M. Kenney, Pharm.D., BCPS, AQ-ID, is Pharmacy Specialist, Antimicrobial Stewardship; Mary Bloome, B.S.Pharm., is Clinical Pharmacist; and Jane McDonnell, Pharm.D., is Clinical Pharmacist, Henry Ford Hospital, Detroit, MI. Jennifer Rodriguez, Pharm.D., BCPS, is Clinical Pharmacist, Henry Ford Hospital, and Inpatient Pharmacy Manager, St. Joseph Mercy Chelsea, Chelsea, MI. Allison Weinmann, M.B.B.S., FRACP, is Senior Staff, Infectious Diseases Division, Henry Ford Hospital, and Clinical Assistant Professor, Wayne State University School of Medicine, Detroit. Paul E. Kilgore, M.P.H., M.D., is Associate Professor and Director of Research, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. Susan L. Davis, Pharm.D., is Infectious Diseases Pharmacy Specialist, Henry Ford Hospital, and Clinical Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. sldavis@wayne.edu.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Davis
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D024382:Professional Role; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents