Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the "five Moments of Antimicrobial Prescribing"

Misha Devchand, Andrew J. Stewardson, Karen F. Urbancic, Sharmila Khumra, Andrew A. Mahony, Steven Walker, Kent Garrett, M. Lindsay Grayson, Jason A. Trubiano

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective:The primary objective of this study was to examine the impact of an electronic medical record (EMR)-driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed "5 Moments of Antimicrobial Prescribing" metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.Methods:A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS recommendation was made. The impact of the ICU-AMS round on antimicrobial appropriateness was evaluated using point-prevalence survey data.Results:For the 202 patients, 412 recommendations were made in accordance with the "5 Moments" metric. The most common recommendation made by the ICU-AMS team was moment 3 (discontinuation), which comprised 173 of 412 recommendations (42.0%), with an acceptance rate of 83.8% (145 of 173). Data collected for point-prevalence surveys showed an increase in prescribing appropriateness from 21 of 45 (46.7%) preintervention (October 2016) to 30 of 39 (76.9%) during the study period (September 2017).Conclusions:The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our "5 Moments of Antimicrobial Prescribing" metric provides a framework for measuring AMS recommendation compliance.

Original languageEnglish
Pages (from-to)1170-1175
Number of pages6
JournalInfection Control and Hospital Epidemiology
Volume40
Issue number10
DOIs
Publication statusPublished - 1 Oct 2019

Cite this

Devchand, Misha ; Stewardson, Andrew J. ; Urbancic, Karen F. ; Khumra, Sharmila ; Mahony, Andrew A. ; Walker, Steven ; Garrett, Kent ; Lindsay Grayson, M. ; Trubiano, Jason A. / Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round : Assessing the "five Moments of Antimicrobial Prescribing". In: Infection Control and Hospital Epidemiology. 2019 ; Vol. 40, No. 10. pp. 1170-1175.
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abstract = "Objective:The primary objective of this study was to examine the impact of an electronic medical record (EMR)-driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed {"}5 Moments of Antimicrobial Prescribing{"} metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.Methods:A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS recommendation was made. The impact of the ICU-AMS round on antimicrobial appropriateness was evaluated using point-prevalence survey data.Results:For the 202 patients, 412 recommendations were made in accordance with the {"}5 Moments{"} metric. The most common recommendation made by the ICU-AMS team was moment 3 (discontinuation), which comprised 173 of 412 recommendations (42.0{\%}), with an acceptance rate of 83.8{\%} (145 of 173). Data collected for point-prevalence surveys showed an increase in prescribing appropriateness from 21 of 45 (46.7{\%}) preintervention (October 2016) to 30 of 39 (76.9{\%}) during the study period (September 2017).Conclusions:The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our {"}5 Moments of Antimicrobial Prescribing{"} metric provides a framework for measuring AMS recommendation compliance.",
author = "Misha Devchand and Stewardson, {Andrew J.} and Urbancic, {Karen F.} and Sharmila Khumra and Mahony, {Andrew A.} and Steven Walker and Kent Garrett and {Lindsay Grayson}, M. and Trubiano, {Jason A.}",
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Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round : Assessing the "five Moments of Antimicrobial Prescribing". / Devchand, Misha; Stewardson, Andrew J.; Urbancic, Karen F.; Khumra, Sharmila; Mahony, Andrew A.; Walker, Steven; Garrett, Kent; Lindsay Grayson, M.; Trubiano, Jason A.

In: Infection Control and Hospital Epidemiology, Vol. 40, No. 10, 01.10.2019, p. 1170-1175.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round

T2 - Assessing the "five Moments of Antimicrobial Prescribing"

AU - Devchand, Misha

AU - Stewardson, Andrew J.

AU - Urbancic, Karen F.

AU - Khumra, Sharmila

AU - Mahony, Andrew A.

AU - Walker, Steven

AU - Garrett, Kent

AU - Lindsay Grayson, M.

AU - Trubiano, Jason A.

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Y1 - 2019/10/1

N2 - Objective:The primary objective of this study was to examine the impact of an electronic medical record (EMR)-driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed "5 Moments of Antimicrobial Prescribing" metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.Methods:A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS recommendation was made. The impact of the ICU-AMS round on antimicrobial appropriateness was evaluated using point-prevalence survey data.Results:For the 202 patients, 412 recommendations were made in accordance with the "5 Moments" metric. The most common recommendation made by the ICU-AMS team was moment 3 (discontinuation), which comprised 173 of 412 recommendations (42.0%), with an acceptance rate of 83.8% (145 of 173). Data collected for point-prevalence surveys showed an increase in prescribing appropriateness from 21 of 45 (46.7%) preintervention (October 2016) to 30 of 39 (76.9%) during the study period (September 2017).Conclusions:The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our "5 Moments of Antimicrobial Prescribing" metric provides a framework for measuring AMS recommendation compliance.

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