In the Journals

‘5 Moments of Antimicrobial Prescribing’ metric increases prescribing appropriateness

An electronic medical record-driven antimicrobial stewardship program implemented in an Australian ICU was associated with high clinician compliance with recommendations and an improvement in the appropriateness of antibiotic prescriptions, researchers reported.

The study’s primary objective was to analyze the impact of EMR-driven antimicrobial stewardship in the ICU on clinician compliance with recommendations. Secondary objectives included measuring the impact on antibiotic appropriateness and the use of high-priority target antimicrobials.

The stewardship program was based on the “5 Moments of Antimicrobial Prescribing,” a metric developed by the hospital. The “5 Moments” included:

  • Escalation,
  • De-escalation,
  • Discontinuation,
  • Switch and
  • Optimization.

The framework recalls “My 5 Moments for Hand Hygiene,” an approach developed by WHO to define the critical moments when hand hygiene should be performed by health care workers. 

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An electronic medical record-driven antimicrobial stewardship program implemented in an Australian ICU was associated with high clinician compliance with recommendations and an improvement in the appropriateness of antibiotic prescriptions, researchers reported. Source: Devchand M, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2019.218.

In the current study, researchers conducted a prospective review of the implementation of — and compliance with — the “5 Moments of Antimicrobial Prescribing” metric, and collected additional data when a new recommendation was made.

The study included 202 patients treated between Aug. 7, 2017, and Dec. 31, 2017, at Austin Health in Heidelberg, Australia, for whom 412 recommendations were guided by the “5 Moments” metric. Moment three — discontinuation — comprised 42% of the metric-based recommendations, and was accepted 83.8% of the time, the researchers reported.

According to the study, point-prevalence survey data demonstrated an increase in prescribing appropriateness from 46.7% in the preintervention period to 76.9% in September 2017, during the study period.

When assessing high-priority target antimicrobial use, the researchers saw an immediate reduction in the use of meropenem (−40.5%; 95% CI, −52.9% to −24.8%), piperacillin-tazobactam (−39.8%; 95% CI, −50.8% to −26.6%) and vancomycin (−36.6%; 95% CI, −48.3% to −22.4%) associated with the implementation of the intervention, but they did not see a reduction in ceftriaxone use (1.4%; 95% CI, −18.7% to −8.4%). They observed a significant decline in the monthly use of vancomycin (−13.2% [−17.9%, −8.4%]), but not other target drugs.

“The ‘5 Moments of Antimicrobial Prescribing’ metric is a structured model for assessing AMS recommendations and compliance,” the researchers wrote. “ICU-AMS models that integrate the EMR should be encouraged in centers with appropriate digital resources to achieve subsequent positive impacts on antibiotic prescribing.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

An electronic medical record-driven antimicrobial stewardship program implemented in an Australian ICU was associated with high clinician compliance with recommendations and an improvement in the appropriateness of antibiotic prescriptions, researchers reported.

The study’s primary objective was to analyze the impact of EMR-driven antimicrobial stewardship in the ICU on clinician compliance with recommendations. Secondary objectives included measuring the impact on antibiotic appropriateness and the use of high-priority target antimicrobials.

The stewardship program was based on the “5 Moments of Antimicrobial Prescribing,” a metric developed by the hospital. The “5 Moments” included:

  • Escalation,
  • De-escalation,
  • Discontinuation,
  • Switch and
  • Optimization.

The framework recalls “My 5 Moments for Hand Hygiene,” an approach developed by WHO to define the critical moments when hand hygiene should be performed by health care workers. 

#
An electronic medical record-driven antimicrobial stewardship program implemented in an Australian ICU was associated with high clinician compliance with recommendations and an improvement in the appropriateness of antibiotic prescriptions, researchers reported. Source: Devchand M, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2019.218.

In the current study, researchers conducted a prospective review of the implementation of — and compliance with — the “5 Moments of Antimicrobial Prescribing” metric, and collected additional data when a new recommendation was made.

The study included 202 patients treated between Aug. 7, 2017, and Dec. 31, 2017, at Austin Health in Heidelberg, Australia, for whom 412 recommendations were guided by the “5 Moments” metric. Moment three — discontinuation — comprised 42% of the metric-based recommendations, and was accepted 83.8% of the time, the researchers reported.

According to the study, point-prevalence survey data demonstrated an increase in prescribing appropriateness from 46.7% in the preintervention period to 76.9% in September 2017, during the study period.

When assessing high-priority target antimicrobial use, the researchers saw an immediate reduction in the use of meropenem (−40.5%; 95% CI, −52.9% to −24.8%), piperacillin-tazobactam (−39.8%; 95% CI, −50.8% to −26.6%) and vancomycin (−36.6%; 95% CI, −48.3% to −22.4%) associated with the implementation of the intervention, but they did not see a reduction in ceftriaxone use (1.4%; 95% CI, −18.7% to −8.4%). They observed a significant decline in the monthly use of vancomycin (−13.2% [−17.9%, −8.4%]), but not other target drugs.

“The ‘5 Moments of Antimicrobial Prescribing’ metric is a structured model for assessing AMS recommendations and compliance,” the researchers wrote. “ICU-AMS models that integrate the EMR should be encouraged in centers with appropriate digital resources to achieve subsequent positive impacts on antibiotic prescribing.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.