title: Acceptance of Pharmacist-Driven Antimicrobial Stewardship Recommendations With Differing Levels of Physician Involvement in a Children's Hospital.
abstract: This prospective interventional study assessed whether a pharmacist-physician team in a setting where physician support is not provided for daily antimicrobial stewardship (AS) activities would improve later acceptance of pharmacist recommendations once multidisciplinary efforts stopped and the pharmacist again worked alone. This was measured by AS recommendation acceptance rate during 3 study phases wherein AS recommendations were provided by a pharmacist alone (Phase 1), a pharmacist and a physician together (Phase 2), and then a pharmacist alone again (Phase 3). Recommendations were well accepted across all study phases with no differences in recommendation appropriateness or patient clinical outcomes. Prescribers were significantly ( P = .045) more likely to accept recommendations to de-escalate treatment during Phase 3 than during Phase 1. Independently pharmacist-driven AS efforts were generally successful, and recommendations for antimicrobial de-escalation were better accepted after the involvement of an infectious diseases physician.
authors.affiliation: 1 Children's Hospital of Michigan, Detroit, MI, USA.|3 Detroit Medical Center, Detroit, MI, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Molloy
authors.affiliation: 1 Children's Hospital of Michigan, Detroit, MI, USA.|2 Wayne State University, Detroit, MI, USA.|3 Detroit Medical Center, Detroit, MI, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: McGrath
authors.affiliation: 2 Wayne State University, Detroit, MI, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Thomas
authors.affiliation: 2 Wayne State University, Detroit, MI, USA.|3 Detroit Medical Center, Detroit, MI, USA.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: 2 Wayne State University, Detroit, MI, USA.|3 Detroit Medical Center, Detroit, MI, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rybak
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D010348:Patient Care Team; D010595:Pharmacists / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D000890:Anti-Infective Agents
keywords: antimicrobial stewardship; pediatric; pharmacist; physician