title: A Quality Assessment of a Collaborative Model of a Pediatric Antimicrobial Stewardship Program.
abstract: Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model.
  
  
  
  The collaborative ASP model incorporated key strategies of education, antimicrobial restriction, day 3 audits, and practice guidelines. High-use and/or high-cost antimicrobial agents were chosen with audits targeting vancomycin, caspofungin, and meropenem. The electronic medical record was used to identify patients requiring day 3 audits and to communicate ASP recommendations. Segmented regression analyses were used to analyze quarterly antimicrobial agent prescription data for the institution and selected services over time.
  
  
  
  Initiation of ASP and day 3 auditing was associated with blunting of a preexisting increasing trend for caspofungin drug starts and use and a significant downward trend for vancomycin drug starts (relative change -12%) and use (-25%), with the largest reduction in critical care areas. Although meropenem use was already low due to preexisting requirements for preauthorization, a decline in drug use (-31%, P = .021) and a nonsignificant decline in drug starts (-21%, P = .067) were noted. A 3-month review of acceptance of ASP recommendations found rates of 90%, 93%, and 100% for vancomycin, caspofungin, and meropenem, respectively.
  
  
  
  This nontraditional ASP model significantly reduced targeted drug usage demonstrating acceptance of integration of service-based clinical pharmacists and ID consultants.
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Phuong-Tan
authors.initials: PT
authors.lastname: Nguyen-Ha
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Denise
authors.initials: D
authors.lastname: Howrie
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Kelli
authors.initials: K
authors.lastname: Crowley
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Carol G
authors.initials: CG
authors.lastname: Vetterly
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: William
authors.initials: W
authors.lastname: McGhee
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Donald
authors.initials: D
authors.lastname: Berry
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ferguson
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Emily
authors.initials: E
authors.lastname: Polischuk
authors.affiliation: Division of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Maria Mori
authors.initials: MM
authors.lastname: Brooks
authors.affiliation: Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goff
authors.affiliation: Department of Pediatrics, University of Michigan, Ann Arbor, Michigan;
authors.forename: Terri
authors.initials: T
authors.lastname: Stillwell
authors.affiliation: Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and.
authors.forename: Toni
authors.initials: T
authors.lastname: Darville
authors.affiliation: Departments of Critical Care Medicine.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Thompson
authors.affiliation: Surgery, and.
authors.forename: James E
authors.initials: JE
authors.lastname: Levin
authors.affiliation: Surgery, and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Marian G
authors.initials: MG
authors.lastname: Michaels
authors.affiliation: Surgery, and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Michael.green@chp.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Green
mesh_terms: D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D003299:Cooperative Behavior; D017046:Cost Savings; D016527:Drug Costs; D017723:Drug Utilization Review; D006776:Hospitals, Pediatric; D006801:Humans; D008485:Medical Audit; D010414:Pennsylvania; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011785:Quality Assurance, Health Care
chemical_list: D000890:Anti-Infective Agents