The stewardship pharmacist reviews JT’s antibiotics and decides to intervene by recommending that the team stop piperacillin-tazobactam given the lack of Gram-negative organisms and the worsening renal function. The stewardship pharmacist also asks the team to consider stopping clindamycin if there is adequate source control.

1. Find at least 1 study (primary literature, not review articles) that illustrates the implementation of one of the stewardship strategies below:

· Antibiotic time-out/stop order

· Clinical decision support

· IV to oral conversions

· Antibiograms

· Beta-lactam allergy assessment program

The summary of your study should include:

A. A general description of the stewardship strategy itself.

B. Location/time frame (e.g., VA outpatient clinics in 2005, academic medical centers in 2015).

C. Time of study (e.g., retrospective, prospective, randomized controlled trial, quasi-experimental, etc.).

D. Important baseline characteristics of the population studied.

E. A clear, detailed description of the intervention and how it was implemented.

F. Results of the outcomes being assessed and whether or not the findings were in line with your expectations or were surprising.

G. Limitations to the study.

H. If a negative study (intervention did not provide any benefits), possible explanations for why not benefits were found.

I. If a positive study, what is the feasibility of implementing this strategy? What barriers might there be to implementation?

J. Pros and cons of the strategy (you may use other references to find these)

 

2. A patient case that highlights the intervention you chose. The case should provide a realistic scenario with data that is consistent with the disease state you chose. All medications should be provided with an appropriate dose, route, and frequency. The patient case should be in the following format (with the below example being an example of minimum requirement):

 

EXAMPLE:

Post-prescriptive review and feedback case

JT is a 47-year-old man who presents to the emergency department with a large area of erythema, warmth and swelling on his right calf. He first noticed it 2 days after he hit his leg on the corner of his bed frame. The ED team is concerned for necrotizing fasciitis and wants to start JT on antibiotics.

 

PMH: DMII, HTN, HLD, CAD

Social hx: drinks 2 beers a day and more on the weekends. Currently unemployed

Surgical hx: none

 

Ht: 5’10” Wt: 165lb

Tm: 99.1°F HR: 87bpm BP: 87/62mmHG

 

Allergies: none

 

PMH: DMII, HTN, depression

Medications: metformin, lisinopril, sertraline

 

Labs:
Na	138 mEq/L	Glu	99 mg/dL	AST	72 IU/L	WBC	17.4 k/cmm
K	4.8 mEq/L	Ca	9.1 mg/dL	ALT	43 IU/L	Hgb	10.1 g/dL
Cl	101 mEq/L	Mg	1.9 mg/dL	Alb	3.0 g/dL	Hct	35%
CO2	16 mEq/L	PO4	3.1 mg/dL	T.bili	1.1mg/dL	Plt	228 k/cmm
BUN	23 mg/dL			Lactate	3.2mmol/L	INR	1.1
Scr   QTc	1.1 mg/dL   502 msec

 

 

1. Given the severity of JT’s illness and his location (emergency department) there are no restrictions on antimicrobials, he is started on vancomycin 1.25g IV q12h, piperacillin-tazobactam 3.375g IV q8h (infused over 4 hours) and clindamycin 900mg IV q8h.

 

2. On day 2 of JT’s hospitalization, he is recovering from surgery and the following data returns:

Labs:

Blood Cx (x2): no growth x 48hours

Wound culture (intra-op): Moderate growth of MRSA

Na	142 mEq/L	WBC	10.4 k/cmm
K	4.5 mEq/L	Hgb	8.9 g/dL
Cl	99 mEq/L	Hct	32%
CO2	18 mEq/L	Plt	189 k/cmm
BUN	33 mg/dL
Scr	1.5 mg/dL

 

3. The stewardship pharmacist reviews JT’s antibiotics and decides to intervene by recommending that the team stop piperacillin-tazobactam given the lack of Gram-negative organisms and the worsening renal function. The stewardship pharmacist also asks the team to consider stopping clindamycin if there is adequate source control.