Improvement In Pharmacist-initiated Antimicrobial Stewardship Interventions Following The Implementation Of A Customized Digital Solution.

• By: SCHUTTE, Kristien (Netcare, South Africa)
• Co-author(s): Mrs Kristien Schutte (Netcare Ltd, Johannesburg, South Africa)
  Mrs Anje Laubscher (Netcare Ltd, Johannesburg, South Africa)
  Mrs Maletje Griesel (Netcare Ltd, Johannesburg, South Africa)
  Mrs Kim Nagoor (Netcare Ltd, Johannesburg, South Africa)
  Mrs Angeliki Messina (Netcare Ltd, Johannesburg, South Africa)
  
• Abstract:

  Improvement in pharmacist-initiated antimicrobial stewardship interventions following the implementation of a customized digital solution.
  
  K Schutte, A Laubscher, K Nagoor, M Griesel, A Messina
  
  Netcare Ltd
  
  Introduction
  
  Pharmacists play a crucial role in antimicrobial stewardship programs, which aim to improve the appropriate use of antimicrobials and combat antimicrobial resistance. Previous studies have demonstrated that pharmacists play a vital role as part of the multi-disciplinary team in contributing towards better outcomes, reduced mortality, and effective antimicrobial management. The adoption of digital tools by pharmacists has assisted in empowering health professionals to make informed decisions and optimize antimicrobial therapy.
  
  Method
  
  A customized digital solution designed by pharmacists for pharmacists was introduced to 46 South African private hospitals in August 2022. This system comprehensively delivers information on antimicrobial therapy, laboratory results, and microbiology findings, enabling pharmacists to form a holistic view of infection-related matters of high-risk patients. The system assists in directing pharmacists to patients with potential antimicrobial therapy incongruencies and guides on possible actions required to remedy them. The system also ensures auditing of high-risk antimicrobials and provides a platform to document and execute applicable recommendations.
  
  Results
  
  Over an 18-month period, the introduction of this system facilitated 6 876 additional interventions with an intervention rate increase from 14.34% to 25.52%. The acceptance rate by prescribers also increased by 9.11% from 69.02% to 78.13%. The intervention types that showed the greatest increase were drug bug mismatch in treatment, duplicate antimicrobial spectrum, dose recommendation, de-escalation in therapy, escalation in therapy, initiation of therapy and assessment of source control. Duration more than 7 days remained the most common intervention performed. The antimicrobials requiring the most interventions where: meropenem followed by ceftriaxone and ertapenem.
  
  Conclusion
  
  Introducing a customized digital solution for executing antimicrobial stewardship increased the number of interventions performed by pharmacists. The system assisted pharmacists in their decision-making processes, created confidence in their abilities and led to more clinically robust interventions and greater acceptance thereof from doctors.