‘Handshake stewardship’ effective and sustainable

Findings from an 8-year retrospective assessment of a handshake stewardship approach implemented at Children’s Hospital Colorado — characterized by team evaluation of prescribed antimicrobials and in-person feedback — showed that it is an effective and sustainable approach for stewardship efforts, researchers reported.

In a related editorial, Debra A. Goff, PharmD, FCCP, associate professor of infectious diseases at The Ohio State University Wexner Medical Center, and Ravina Kullar, PharmD, MPH, a senior medical scientist for Gilead Sciences, explained that antimicrobial stewardship approaches usually include restricted lists of antimicrobials that require prior authorization and prospective audit and feedback. They also noted that communication between antimicrobial stewardship team members and physicians is usually conducted electronically or using phones or pagers.

“Handshake stewardship does not use prior authorization, but rather, the [antimicrobial stewardship program (ASP)] physician and pharmacist reviews all antimicrobials at two time points (24 and 48-72 hours) and then makes daily rounds,” they wrote. “They meet and greet clinicians with a ‘perfect handshake’ and then make their recommendation and intervention.”

Christine E. MacBrayne, PharmD, MSCS, and colleagues at Children’s Hospital Colorado noted that the handshake stewardship strategy decreased the use of anti-infectives and costs during its pilot year in 2013. In the current study, they sought to evaluate the program’s impact following 5 years of implementation by measuring hospitalwide use of antibiotics, antivirals and antifungals from October 2010 to October 2018.

According to the findings, the mean use of anti-infectives significantly decreased hospitalwide. Specifically, it decreased from 891 days of therapy per 1,000 patient days (DOT/1000PD) during the preimplementation phase (95% CI, 859-923) to 655 DOT/1000 5 years after implementation (95% CI, 637-694).

The researchers suggested that this decrease was in large part due to decreased antibacterial use, which declined from 704 DOT/1000 PD during preimplementation (95% CI, 686–722) to 544 DOT/1000PD after implementation (95% CI, 525-562).

Moreover, before implementation, 65% of children received an anti-infective during admission compared with 52% after implementation.

MacBrayne and colleagues reported no detrimental effects on severity-adjusted mortality, readmissions or lengths of stay.

Goff and Kullar said communication skills and relationship building are important takeaways from the success of the approach.

“ASP recommendations and interventions are made to physicians who are not seeking our advice. It is easy to dismiss the ASP pharmacist and physician when there is no professional relationship,” they wrote. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures. Groff reports receiving consulting fees from BioK and Tetraphase, payments to her institution from Merck and Pfizer and payments from Astellas, outside of the submitted work. Kullar reports receiving stocks/stock options from Cubist, outside of the submitted work.

Findings from an 8-year retrospective assessment of a handshake stewardship approach implemented at Children’s Hospital Colorado — characterized by team evaluation of prescribed antimicrobials and in-person feedback — showed that it is an effective and sustainable approach for stewardship efforts, researchers reported.

In a related editorial, Debra A. Goff, PharmD, FCCP, associate professor of infectious diseases at The Ohio State University Wexner Medical Center, and Ravina Kullar, PharmD, MPH, a senior medical scientist for Gilead Sciences, explained that antimicrobial stewardship approaches usually include restricted lists of antimicrobials that require prior authorization and prospective audit and feedback. They also noted that communication between antimicrobial stewardship team members and physicians is usually conducted electronically or using phones or pagers.

“Handshake stewardship does not use prior authorization, but rather, the [antimicrobial stewardship program (ASP)] physician and pharmacist reviews all antimicrobials at two time points (24 and 48-72 hours) and then makes daily rounds,” they wrote. “They meet and greet clinicians with a ‘perfect handshake’ and then make their recommendation and intervention.”

Christine E. MacBrayne, PharmD, MSCS, and colleagues at Children’s Hospital Colorado noted that the handshake stewardship strategy decreased the use of anti-infectives and costs during its pilot year in 2013. In the current study, they sought to evaluate the program’s impact following 5 years of implementation by measuring hospitalwide use of antibiotics, antivirals and antifungals from October 2010 to October 2018.

According to the findings, the mean use of anti-infectives significantly decreased hospitalwide. Specifically, it decreased from 891 days of therapy per 1,000 patient days (DOT/1000PD) during the preimplementation phase (95% CI, 859-923) to 655 DOT/1000 5 years after implementation (95% CI, 637-694).

The researchers suggested that this decrease was in large part due to decreased antibacterial use, which declined from 704 DOT/1000 PD during preimplementation (95% CI, 686–722) to 544 DOT/1000PD after implementation (95% CI, 525-562).

Moreover, before implementation, 65% of children received an anti-infective during admission compared with 52% after implementation.

MacBrayne and colleagues reported no detrimental effects on severity-adjusted mortality, readmissions or lengths of stay.

Goff and Kullar said communication skills and relationship building are important takeaways from the success of the approach.

“ASP recommendations and interventions are made to physicians who are not seeking our advice. It is easy to dismiss the ASP pharmacist and physician when there is no professional relationship,” they wrote. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures. Groff reports receiving consulting fees from BioK and Tetraphase, payments to her institution from Merck and Pfizer and payments from Astellas, outside of the submitted work. Kullar reports receiving stocks/stock options from Cubist, outside of the submitted work.