#102 – Oh, the Places Stewardship Will Go! Best Practices for Outpatient Antibiotic Stewardship and Transitions of Care
Aug 23, 2024
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In this engaging discussion, Dr. Erica Stohs, an infectious diseases physician and policy advisor, Dr. Ryan Stevens, a pharmacist specializing in antimicrobial stewardship, and Jayme McRae, a clinical pharmacology consultant, dive into the nuances of antibiotic stewardship. They share best practices for managing outpatient antibiotic use, the importance of clear communication during patient transitions, and innovative strategies like the 'viral RX pad.' The trio also addresses challenges like diagnosing infections in elderly patients and the role of pharmacists in enhancing care.
Effective communication and interventions during transitions of care are crucial for optimizing antibiotic therapy upon patient discharge.
Education on differentiating UTIs is vital in outpatient settings to reduce unnecessary antibiotic prescriptions stemming from misdiagnosis.
Leveraging technology, such as EHR decision support tools, can streamline stewardship efforts and promote more accurate antibiotic prescribing practices.
Deep dives
Antibiotic Stewardship in Transitions of Care
Antimicrobial stewardship during transitions of care is crucial, particularly for patients discharged on antibiotics. Many patients, estimated at one in eight, receive antibiotics during hospital discharge, often leading to antibiotic overuse such as prolonged durations or inappropriate drug choices. Effective communication between healthcare teams is essential to ensure patients are discharged with optimal therapy. Interventions such as pharmacist-led reviews at discharge and enhanced electronic health record (EHR) integration can significantly improve prescribing accuracy and outcomes.
The Role of Education in Antimicrobial Stewardship
Education is pivotal in shaping antibiotic prescribing practices in outpatient settings. Providers often associate alterations in patient mental status, such as confusion, with urinary tract infections (UTIs), leading to unnecessary antibiotic prescriptions. Targeted educational initiatives that clarify the difference between symptomatic UTIs and those that don't require treatment can lead to better prescribing practices. Providing easily accessible information and creating a culture of knowledge sharing within healthcare teams are critical components of effective stewardship.
Unique Challenges in Outpatient Stewardship
Outpatient stewardship presents distinct challenges, particularly regarding patient interactions and the follow-through of treatment plans. Patients often arrive with specific expectations, leading to an increased likelihood of unnecessary antibiotic requests. The issue is compounded by patients accessing antibiotics from various sources outside of the healthcare system. Implementing delayed prescribing strategies and offering care packages with non-antibiotic treatment options can provide better patient education while reducing the demand for antibiotics.
Leveraging Technology for Better Antibiotic Usage
Utilizing technology effectively can streamline antibiotic stewardship efforts and enhance patient care. Electronic health records (EHRs) can have built-in decision support tools that guide providers towards appropriate antibiotic prescribing. Customizing EHR defaults to align with best practices—such as setting shorter antibiotic durations—can lead to significant reductions in unnecessary prescriptions. This approach emphasizes that making the right choice the easiest option for clinicians can foster adherence to stewardship principles.
Engaging Healthcare Teams in Stewardship Efforts
Successful antibiotic stewardship requires engaging all members of the healthcare team, from hospital staff to outpatient providers. Collaborative efforts in very different settings can lead to the successful implementation of stewardship initiatives. Regular feedback loops that focus on positive reinforcement rather than punitive measures encourage providers to actively participate in stewardship practices. By fostering interprofessional collaboration and maintaining open lines of communication, the overall efficacy of antibiotic stewardship programs can be significantly enhanced.
In this episode, Drs. Erica Stohs, Ryan Stevens, and Jame McCrae join Dr. Megan Klatt to discuss antimicrobial stewardship practices at transitions of care and in the outpatient setting. Hear from the experts on how to establish programs in this space, best practices for data/reporting, and other tips for stewardship intervention.
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References:
Pharmacist-Driven Transitions of Care Practice Model for Prescribing Oral Antimicrobials at Hospital Discharge. 10.1001/jamanetworkopen.2022.11331
From concept to reality: Building an ambulatory antimicrobial stewardship program. 10.1002/jac5.1528
Cracking the code(s): Optimization of encounter-level diagnosis coding to inform outpatient antimicrobial stewardship data modeling. 10.1017/ice.2023.296
Antibiotic Prescribing Variability in a Large Urgent Care Network: A New Target for Outpatient Stewardship. 10.1093/cid/ciz910
