Antimicrobial stewardship initiative on prescribing at discharge from a community medical center.

Objective: Assess the impact of a multifaceted discharge antimicrobial stewardship initiative by comparing proportion of appropriate antimicrobial regimens before and after implementation.

Design: Cohort study.

Setting: Non-teaching, urban, community medical center.

Patients: Adult patients prescribed an oral antimicrobial regimen at discharge were included. Patients were randomized irrespective of encounter type or discharge disposition. Pregnant and post-partum patients were excluded.

Methods: A discharge antimicrobial stewardship program was implemented at our facility. Components of the initiative included development of a comprehensive, institution-specific, inpatient and outpatient prescribing guideline, extensive face-to-face clinician education, and real-time, pharmacist prospective audit and feedback at discharge. The validated National Antimicrobial Prescribing Survey tool was used to then categorize one hundred randomized discharge antimicrobial prescriptions as appropriate (optimal or adequate), inappropriate (suboptimal or inadequate), or not assessable. Hospital-specific treatment guidelines, literature references, and patient-specific factors were used to determine appropriateness.

Results: One hundred antimicrobial regimens selected via random sampling were analyzed in each cohort. The proportion of appropriate antimicrobial regimens increased by 15% after program implementation (47% vs 62%, P = .03).

Conclusions: Study results highlight the positive impact of a multidisciplinary, multipronged approach in improving discharge antimicrobial prescribing.