Formalization of an antimicrobial stewardship program in a small community hospital

Purpose. Results of a study to formalize an antimicrobial stewardship program (ASP) in a small community hospital are presented. Methods. The formalization process began with a gap analysis of the hospital's antimicrobial services, followed by the development of a fully integrated, multipharmacist ASP. The impact was studied with an institutional review board-approved study design. Retrospective pre-ASP data were pulled from March 1 to June 30, 2012 and 2013 patient records; prospective post-ASP data were collected for March 1 to June 30, 2015. Analyses included descriptive and inferential statistics. Results. No significant differences in age, percent of patients on antimicrobials, or length of stay were found between the 2 groups. The post- ASP period showed a 30.2% decrease in defined daily dose (DDD) per 1,000 patient-days for the 18 most frequently used parenteral antimicrobial agents (p < 0.001). For all nursing units except nursery, the vancomycin and piperacillin-Tazobactam DDD per 1,000 patient-days decreased by 63% (p < 0.001) and 36% (p < 0.001), respectively. Mean antibiotic charges per patient-day decreased from $10.44 to $3.09 (p < 0.001) and from $18.04 to $11.29 (p < 0.001) for vancomycin and piperacillin-Tazobactam, respectively. Pharmacist interventions increased from 19.3 per 1,000 patients to 104.3 per 1,000 patients. Deescalation of therapy was the most common intervention (46% and 29%) in both time periods. Conclusion. In a small community hospital, a new formalized ASP with pharmacists showed a decrease in the DDD per 1,000 patient-days and average antibiotic charges per patient-day for vancomycin and piperacillin-Tazobactam within 4 months of implementation. The approach used to develop a formalized ASP could be used as an example for development in small community hospitals with similar resources.