In the Journals

Stewardship-focused rounds improve guideline adherence among medical residents

Kali M. VanLangen, PharmD, BCPS
Kali M. VanLangen

Adding dedicated, stewardship-focused rounds to medical residents’ curriculum leads to increased guideline adherence, especially for duration of therapy, according to a study published in Infection Control & Hospital Epidemiology.

“We work with physicians daily to improve antibiotic prescribing and ensure our patients are receiving optimal antibiotics for the guideline-recommended durations. Based on these daily experiences and knowing the education methods that were being employed, it seemed like some academic teams and physicians were doing a better job at adhering to these recommendations than others,” Kali M. VanLangen, PharmD, BCPS, professor in the department of pharmacy practice at Ferris State University in Big Rapids, MI, told Infectious Disease News. “We also thought those individuals who received more frequent education sessions would be more willing to accept pharmacist recommendations to improve antimicrobial prescribing than those who who did not.”

VanLangen and colleagues performed a retrospective cohort study evaluating guideline-concordant antibiotic prescribing for three common infectious among family medicine (FM) and internal medicine (IM) resident services and hospitalists. The study included adult patients admitted between July 1, 2016 and June 30, 2017 with a discharge diagnosis of pneumonia, cellulitis and urinary tract infections. The goal of the study was to see if there was a difference in prescribing habits to illustrate the benefit of these sessions, according to VanLangen.

In total, 295 patients were included in the study (96 FM, 69 IM and 130 hospitalist). The percentage of patients receiving guideline-concordant antibiotic selection empirically was comparable between groups for all diagnoses (FM, 87.5%; IM, 87%; hospitalist, 83.8%), with no differences observed in appropriate definitive antibiotic selection among groups (FM,92.4%; IM,89.1%; hospitalist, 89.9%). Additionally, the FM resident service was more likely than the IM resident service and the hospitalists to prescribe a guideline-concordant duration of therapy, (FM, 74%; IM, 56.5%; hospitalists, 44.6%; P < .001).

According to VanLangen, these findings show that prescribers are “doing a good job selecting appropriate antibiotics” for the three studied infections, demonstrating that most prescribers are following the institution’s empiric therapy guidelines to choose the correct antimicrobial therapy, but also that education sessions may have a positive impact on selecting the correct duration of therapy when treating infections.

“Frequent educational sessions with the antimicrobial stewardship team have a positive impact on the training of medical residents in terms of appropriate selection and duration of antimicrobial prescribing. The goal is that developing appropriate prescribing habits during training will impact future prescribing habits to have an overall impact on antimicrobial resistance,” VanLangen said.

In addition, if an institution has an antimicrobial stewardship team, “this project may be generalizable, according to VanLangen.

“These educational sessions require time from both the stewardship team as well as the other medical teams,” he concluded. “If institutions are looking to improve their antimicrobial prescribing habits, employing these education sessions may result in more appropriate antibiotic selection and duration.” – by Caitlyn Stulpin

Disclosure: VanLangen reports no relevant financial disclosures.

Kali M. VanLangen, PharmD, BCPS
Kali M. VanLangen

Adding dedicated, stewardship-focused rounds to medical residents’ curriculum leads to increased guideline adherence, especially for duration of therapy, according to a study published in Infection Control & Hospital Epidemiology.

“We work with physicians daily to improve antibiotic prescribing and ensure our patients are receiving optimal antibiotics for the guideline-recommended durations. Based on these daily experiences and knowing the education methods that were being employed, it seemed like some academic teams and physicians were doing a better job at adhering to these recommendations than others,” Kali M. VanLangen, PharmD, BCPS, professor in the department of pharmacy practice at Ferris State University in Big Rapids, MI, told Infectious Disease News. “We also thought those individuals who received more frequent education sessions would be more willing to accept pharmacist recommendations to improve antimicrobial prescribing than those who who did not.”

VanLangen and colleagues performed a retrospective cohort study evaluating guideline-concordant antibiotic prescribing for three common infectious among family medicine (FM) and internal medicine (IM) resident services and hospitalists. The study included adult patients admitted between July 1, 2016 and June 30, 2017 with a discharge diagnosis of pneumonia, cellulitis and urinary tract infections. The goal of the study was to see if there was a difference in prescribing habits to illustrate the benefit of these sessions, according to VanLangen.

In total, 295 patients were included in the study (96 FM, 69 IM and 130 hospitalist). The percentage of patients receiving guideline-concordant antibiotic selection empirically was comparable between groups for all diagnoses (FM, 87.5%; IM, 87%; hospitalist, 83.8%), with no differences observed in appropriate definitive antibiotic selection among groups (FM,92.4%; IM,89.1%; hospitalist, 89.9%). Additionally, the FM resident service was more likely than the IM resident service and the hospitalists to prescribe a guideline-concordant duration of therapy, (FM, 74%; IM, 56.5%; hospitalists, 44.6%; P < .001).

According to VanLangen, these findings show that prescribers are “doing a good job selecting appropriate antibiotics” for the three studied infections, demonstrating that most prescribers are following the institution’s empiric therapy guidelines to choose the correct antimicrobial therapy, but also that education sessions may have a positive impact on selecting the correct duration of therapy when treating infections.

“Frequent educational sessions with the antimicrobial stewardship team have a positive impact on the training of medical residents in terms of appropriate selection and duration of antimicrobial prescribing. The goal is that developing appropriate prescribing habits during training will impact future prescribing habits to have an overall impact on antimicrobial resistance,” VanLangen said.

In addition, if an institution has an antimicrobial stewardship team, “this project may be generalizable, according to VanLangen.

“These educational sessions require time from both the stewardship team as well as the other medical teams,” he concluded. “If institutions are looking to improve their antimicrobial prescribing habits, employing these education sessions may result in more appropriate antibiotic selection and duration.” – by Caitlyn Stulpin

Disclosure: VanLangen reports no relevant financial disclosures.