Improvements in Quality Indicators for the Treatment
of Infectious Diseases with Intervention by
an Antimicrobial Stewardship Team
Hiroshi Sasano.1) Toshihiro Yoshizawa.1) Takaaki Kawakami.2)
Toshihiro Takahashi.2) Mai Suzuki.3) Yukiko Fukui.3)
Yuki Uehara.3)4)5) Ryutarou Arakawa.1) Takashi Miida.2)
Satoshi Hori.6) Toshio Naito.3)
1）Department of Pharmacy, Juntendo University Hospital
2）Department of Clinical Laboratory, Juntendo University Hospital
3）General Medicine, Hirosaki University Graduate School of Medicine
4）Department of Clinical Laboratory, St Luke’s International Hospital
5）Department of Infectious Diseases, St Luke’s International Hospital
6）Department of Infection Control Science, Juntendo University Graduate School of Medicine
[Objective] The objective was to describe the activities and present the results of the in-house Antimicrobial Stewardship Team (AST) of Juntendo University Hospital, which undertook activities to achieve the “4R” concept (Right drug, Right time, Right dose, Right duration), including appropriate interventions targeting physicians to ensure proper prescribing practices.
[Methods] Taking into account the previous mode of in-house antimicrobial drug prescription,quality indicators were defined for the individual Rs：(1) proportion of blood culture tests implemented prior to administration of carbapenems, with monitoring started in January 2018, and in May, the results fed back to the primary physicians involved；(2) therapeutic monitoring of vancomycin (VCM) via pharmacist intervention, with training for doctors and nurses since 2016, and a full-time working schedule introduced for the AST pharmacists in 2018；(3) proportion of rightdose prescription of cefmetazole (CMZ), with feedback of the preceding data on CMZ usage to the primary physicians and the prescription ordering system revamped in August 2017；and (4) the proportion of patients who underwent hotline system-mediated interventions during long-term carbapenem treatment, which checked the target patient once every 10 days in 2016, and then the check interval was changed to once per week since 2017. The AST monitored these indicators, providing periodic feedback of data and interventions to the healthcare providers, if necessary.
[Methods] Healthcare providers (prescribers)
[Results] Following the AST interventions, the proportion of blood culture tests reached > 80%. The mean proportion of therapeutic VCM monitoring improved to involve nearly all cases in 2018. The validity of CMZ prescription improved through data feedback to the physicians and a revamped drug ordering system that presented a warning message for the right-dose prescription. The fourth indicator also improved by increasing the intervention frequency from once per 10 days to once per 7 days, with nearly all relevant patients followed up during long-term carbapenem use.
[Conclusion] AST activities are promising in terms of the 4R concept, the goal of antimicrobial
Key Words：antimicrobial stewardship, 4R concept, drug resistance