The Journal of the Arkansas Medical Society Med Journal March 2020 Final 2 | Page 13

AFMC: A CLOSER LOOK AT QUALIT Y
greater AS success. Collaborative par-
ticipants learned from one another’s
success and failures, and what could
be useful in their practice settings.
Following the first AS collabora-
tive, Arkansas hospitals meeting all
seven of the CDC’s hospital AS core
elements increased from 43% in
2015 to 63% by 2016. Improvement
continued in meeting all hospital AS
core elements during the second AS
collaborative, increasing from 67%
in 2017 to 79% in 2018. 3 Based on
the 2019 pre- and post-assessment
results of 57 facilities that participated
in the second AS collaborative, 72%
reported gaining needed education
and planned to implement some
aspect of what they learned. The
same percentage of participants
reported implementation of at least
one intervention to improve AS
within their facilities.
IMPROVING ANTIBIOTIC USAGE
1. Limit antibiotic duration by
reassessing patient’s improvement
at 72 hours for evidenced-based
duration of therapy. Pharmacists
can collaborate with physicians
to determine if these lengths of
therapy can be considered based
on clinical improvement:
• Skin and soft tissue infections:
5 days 4,5
• Urinary tract infections: 5-7 days 4,5
• Community-acquired pneumonia:
5 days 4-6
2.Verify penicillin allergy. Although
10% of the population reports a
penicillin allergy, less than 1% has a
true allergy. Pharmacists can assist
physicians to determine if a be-
ta-lactam antibiotic is appropriate 4,7
by assessing patients’ allergy history
and previous antibiotic usage.
3. Avoid treatment of asymptomatic
bacteriuria (ASB). A urine culture
positive with or without pyuria
alone does not indicate a urinary
tract infection (UTI) and could be
ASB if no symptoms are present.
4,8-9
Pharmacists can discourage
unnecessary urine cultures when
no UTI symptoms are present, and
unnecessary antibiotic usage when
ASB is determined.
• 100% of patients with a chronic uri-
nary catheter will grow an organism
from a urine culture with or without
a UTI. 4,9
• A change in urine cloudiness or odor
alone does not indicate a UTI. 4,8-9
• Delirium should be interpreted with
caution since delirium alone has a
low specificity for UTI. 4,9
4. Avoid duplicative anaerobic cover-
age. Unnecessary duplicate anaero-
bic coverage is usually encountered
when one of the following combi-
nations is ordered unless Metroni-
dazole is needed for treatment of
Clostridioides difficile: Piperacillin/
tazobactam + Metronidazole, Mero-
penem + Metronidazole, Ertape-
nem + Metronidazole, Ampicillin/
sulbactam + Metronidazole, Amox-
icillin/clavulanate + Metronidazole,
etc. When Clindamycin is utilized
instead of Metronidazole for an-
aerobic coverage in one of these
combinations, it is also considered
inappropriate unless Clindamycin is
added to reduce toxin production
in necrotizing infections. Pharma-
cists can inform physicians when
unnecessary duplicate coverage is
prescribed. 4
5. Re-assess antibiotic therapy
including anti-Methicillin-resistant
Staphyloccocus aureus (MRSA)
antibiotics. Pharmacists can alert
physicians when new culture infor-
mation is available to de-escalate
antibiotics. An important consider-
ation for de-escalating anti-MRSA
coverage is based on negative
cultures with clinical improvement,
negative MRSA nasal screen in
patients with community-acquired
pneumonia, etc. 4,6,10 Reasons to
continue anti-MRSA antibiotics may
exist when certain types of infec-
tion require a longer duration of
therapy or cultures are not available.
Physicians should be encouraged
by the involvement of Arkansas phar-
macists who have furthered their AS
education. Pharmacists can assist in
improving patient care and outcomes,
education, patient and ASP interven-
tions, and leadership skills to fulfill AS
requirements. s
Dr. Crader is associate professor of
pharmacy practice at UAMS and
co-leads St. Bernard’s AS program.
REFERENCES
1. Clinical Infectious Diseases 2007; 44:159–77.
2. CDC: “What’s New in the Core Elements of
Hospital ASPs, 2019”, Arjun Srinivasan, MD.
3. CDC. Antibiotic Resistance and Patient
Safety Portal. Hospitals Meeting All Seven
Core Elements: 2014-18. https://arpsp.cdc.
gov/profile/geography/5.
4. CDC. 5 Ways Antibiotics Can Be Antibiotics
Aware. https://www.cdc.gov/antibiotic-use/
community/pdfs/Hospital-Pharmacist-
Poster-508.pdf.
5. Clinical Infectious Diseases 2019;69(9):
1476–9.
6. Am J Respir Crit Care Med 2019;200(7): e45–
e67.
7. CDC. Is It Really a Penicillin Allergy? https://
www.cdc.gov/antibiotic-use/community/
pdfs/penicillin-factsheet.pdf.
8. Clinical Infectious Diseases 2010; 50:625-663.
9. Clinical Infectious Diseases 2019; 68(10):
e83-75.
10. Clinical Infectious Diseases 2018; 67(1):1–7.
AFMC WORKS COLLABORATIVELY WITH PROVIDERS,
COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO
PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH
EDUCATION AND EVALUATION. FOR MORE INFORMATION
ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
CALL 1-877-375-5700 OR VISIT AFMC.ORG.
MARCH 2020
Volume 116 • Number 9
MARCH 2020 • 205