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Resource Stewardship

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https://www.readbyqxmd.com/read/28298480/antimicrobial-stewardship-programmes-bedside-rationing-by-another-name
#1
Simon Oczkowski
Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial stewardship programmes are indeed a form of bedside rationing, and explore the risks and benefits of such programmes for individual patients in the intensive care unit, and the critically ill population in general...
March 15, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28295871/promoting-resource-stewardship-reducing-inappropriate-free-thyroid-hormone-testing
#2
Julie A Gilmour, Alanna Weisman, Steven Orlov, Robert J Goldberg, Alyse Goldberg, Hayley Baranek, Geetha Mukerji
RATIONALE: Free thyroxine (fT4) and free triiodothyronine (fT3) tests are often ordered when not clinically warranted. Preventing laboratory overuse by reducing inappropriate fT4 and fT3 testing is one strategy to promote resource stewardship. OBJECTIVES: (1) To characterize the frequency of inappropriate fT4 and fT3 testing and (2) to implement a quality improvement strategy aimed at reducing the number of these tests performed. METHODS: Quality improvement tools were used to create sequential change ideas: (1) education of physicians regarding appropriate indications for ordering fT4/fT3 and (2) implementation of a hospital-wide laboratory and forced-function system with a reflex fT4...
March 14, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28270268/antibiotic-stewardship-new-frontier-familiar-journey
#3
Caren McHenry Martin
Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts...
March 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28261580/a-blueprint-to-evaluate-one-health
#4
Simon R Rüegg, Barry J McMahon, Barbara Häsler, Roberto Esposito, Liza Rosenbaum Nielsen, Chinwe Ifejika Speranza, Timothy Ehlinger, Marisa Peyre, Maurizio Aragrande, Jakob Zinsstag, Philip Davies, Andrei Daniel Mihalca, Sandra C Buttigieg, Jonathan Rushton, Luís P Carmo, Daniele De Meneghi, Massimo Canali, Maria E Filippitzi, Flavie Luce Goutard, Vlatko Ilieski, Dragan Milićević, Helen O'Shea, Miroslav Radeski, Richard Kock, Anthony Staines, Ann Lindberg
One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28225697/who-should-ration
#5
Philip M Rosoff
A principal component of physician decision making is judging what interventions are clinically appropriate. Due to the inexorable and steady increase of health care costs in the US, physicians are constantly being urged to exercise judicious financial stewardship with due regard for the financial implications of what they prescribe. When applied on a case-by-case basis, this otherwise reasonable approach can lead to either inadvertent or overt and arbitrary restriction of interventions for some patients rather than others on the basis of clinically irrelevant characteristics such as ethnicity, gender, age, or skin color...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28173888/current-state-of-antimicrobial-stewardship-in-children-s-hospital-emergency-departments
#6
Rakesh D Mistry, Jason G Newland, Jeffrey S Gerber, Adam L Hersh, Larissa May, Sarah M Perman, Nathan Kuppermann, Peter S Dayan
BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution...
February 8, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28157831/board-characteristics-governance-objectives-and-hospital-performance-an-empirical-analysis-of-german-hospitals
#7
Andrea Thiel, Vera Winter, Vera Antonia Büchner
BACKGROUND: There is a growing need for hospital supervisory boards to support hospital management in different areas, including (financial) monitoring, resource provision, stakeholder relationships, and strategic decision-making. Little is currently known about how boards' emphases on these various governance objectives contribute to performance. PURPOSE: Using a dominant logics perspective, this article aims to detect the governance logics that hospital boards emphasize, to determine whether there are distinct clusters of hospitals with the same sets of emphases, and to show how cluster membership relates to board characteristics and financial performance...
February 2, 2017: Health Care Management Review
https://www.readbyqxmd.com/read/28118861/a-report-of-the-efforts-of-the-veterans-health-administration-national-antimicrobial-stewardship-initiative
#8
Allison A Kelly, Makoto M Jones, Kelly L Echevarria, Stephen M Kralovic, Matthew H Samore, Matthew B Goetz, Karl J Madaras-Kelly, Loretta A Simbartl, Anthony P Morreale, Melinda M Neuhauser, Gary A Roselle
OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities...
January 25, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28112087/tackling-the-climate-targets-set-by-the-paris-agreement-cop-21-green-leadership-empowers-public-hospitals-to-overcome-obstacles-and-challenges-in-a-resource-constrained-environment
#9
E Weimann, B Patel
The healthcare sector itself contributes to climate change, the creation of hazardous waste, use of toxic metals such as mercury, and water and air pollution. To mitigate the effect of healthcare provision on the deteriorating environment and avoid creating further challenges for already burdened health systems, Global Green Hospitals was formed as a global network. Groote Schuur Hospital (GSH), as the leading academic hospital in Africa, joined the network in 2014. Since then, several projects have been initiated to reduce the amount of general waste, energy consumption and food waste, and create an environmentally friendlier and more sustainable hospital in a resource-constrained public healthcare setting...
December 21, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28100141/caring-to-learn-and-learning-to-care
#10
Kristin G Cloyes, Susan J Rosenkranz, Katherine P Supiano, Patricia H Berry, Meghan Routt, Sarah M Llanque, Kathleen Shannon-Dorcy
The increasing numbers of aging and chronically ill prisoners incarcerated in Western nations is well-documented, as is the growing need for prison-based palliative and end-of-life care. Less often discussed is specifically how end-of-life care can and should be provided, by whom, and with what resources. One strategy incorporates prisoner volunteers into end-of-life services within a peer-care program. This article reports on one such program based on focused ethnographic study including in-depth interviews with inmate hospice volunteers, nursing staff, and corrections officers working in the hospice program...
January 2017: Journal of Correctional Health Care
https://www.readbyqxmd.com/read/28093208/selective-reporting-of-antibiotic-susceptibility-test-results-in-european-countries-an-escmid-cross-sectional-survey
#11
Céline Pulcini, Gianpiero Tebano, Nico T Mutters, Evelina Tacconelli, Emmanuelle Cambau, Gunnar Kahlmeter, Vincent Jarlier
Selective reporting of antibiotic susceptibility test (AST) results is one possible laboratory-based antibiotic stewardship intervention. The primary aim of this study was to identify where and how selective reporting of AST results is implemented in Europe both in inpatient and in outpatient settings. An ESCMID cross-sectional, self-administered, internet-based survey was conducted among all EUCIC (European Committee on Infection Control) or EUCAST (European Committee on Antimicrobial Susceptibility Testing) national representatives in Europe and Israel...
February 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28056822/the-first-occurrence-of-a-ctx-m-esbl-producing-escherichia-coli-outbreak-mediated-by-mother-to-neonate-transmission-in-an-irish-neonatal-intensive-care-unit
#12
Ciara O'Connor, Roy K Philip, John Kelleher, James Powell, Alan O'Gorman, Barbara Slevin, Neil Woodford, Jane F Turton, Elaine McGrath, Cathriona Finnegan, Lorraine Power, Nuala H O'Connell, Colum P Dunne
BACKGROUND: Escherichia coli (E. coli) comprise part of the normal vaginal microflora. Transfer from mother to neonate can occur during delivery resulting, sometimes, in neonatal bacterial disease. Here, we aim to report the first outbreak of CTX-M ESBL-producing E. coli with evidence of mother-to-neonate transmission in an Irish neonatal intensive care unit (NICU) followed by patient-to-patient transmission. METHODS: Investigation including molecular typing was conducted...
January 5, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28034534/antimicrobial-stewardship-practices-in-virginia
#13
Kimberly B Lee, Jesus Aaron Ramirez, Rebeccah Collins, John Bucheit, Kakotan Sanogo, Michael P Stevens
The Society of Healthcare Epidemiology of America, the Centers for Disease Control and Prevention, and the President's Council of Advisors on Science and Technology recognize the need to combat antimicrobial resistance through the promotion of antimicrobial stewardship programs. Health care facilities in Virginia were surveyed using a 23-item survey focused on facility characteristics and antimicrobial stewardship strategies. Antimicrobial stewardship activities were highly variable and many are missing key personnel and resources...
December 26, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/28031432/implementation-of-rapid-molecular-infectious-disease-diagnostics-the-role-of-diagnostic-and-antimicrobial-stewardship
#14
REVIEW
Kevin Messacar, Sarah K Parker, James K Todd, Samuel R Dominguez
New rapid molecular diagnostic technologies for infectious diseases enable expedited accurate microbiological diagnoses. However, diagnostic stewardship and antimicrobial stewardship are necessary to ensure that these technologies conserve, rather than consume, additional health care resources and optimally affect patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and to direct testing toward appropriate patients. Antimicrobial stewardship is needed to ensure prompt appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside...
March 2017: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/28027333/personalized-prescription-feedback-using-routinely-collected-data-to-reduce-antibiotic-use-in-primary-care-a-randomized-clinical-trial
#15
Lars G Hemkens, Ramon Saccilotto, Selene Leon Reyes, Dominik Glinz, Thomas Zumbrunn, Oliver Grolimund, Viktoria Gloy, Heike Raatz, Andreas Widmer, Andreas Zeller, Heiner C Bucher
Importance: Feedback interventions using routinely collected health data might reduce antibiotic use nationwide without requiring the substantial resources and structural efforts of other antibiotic stewardship programs. Objective: To determine if quarterly antibiotic prescription feedback over 2 years reduces antibiotic use when implemented in a complex health care system. Design, Setting, and Participants: Pragmatic randomized trial using routinely collected claims data on 2900 primary care physicians with the highest antibiotic prescription rates in Switzerland...
February 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28001135/a-survey-of-physicians-attitudes-toward-decision-making-authority-for-initiating-and-withdrawing-va-ecmo-results-and-ethical-implications-for-shared-decision-making
#16
Ellen C Meltzer, Natalia S Ivascu, Meredith Stark, Alexander V Orfanos, Cathleen A Acres, Paul J Christos, Thomas Mangione, Joseph J Fins
OBJECTIVE: Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27999061/from-guidelines-to-practice-a-pharmacist-driven-prospective-audit-and-feedback-improvement-model-for-peri-operative-antibiotic-prophylaxis-in-34-south-african-hospitals
#17
Adrian J Brink, Angeliki P Messina, Charles Feldman, Guy A Richards, Dena van den Bergh
BACKGROUND: Few data exist on the implementation of process measures to facilitate adherence to peri-operative antibiotic prophylaxis (PAP) guidelines in Africa. OBJECTIVES: To implement an improvement model for PAP utilizing existing resources, in order to achieve a reduction in surgical site infections (SSIs) across a heterogeneous group of 34 urban and rural South African hospitals. METHODS: A pharmacist-driven, prospective audit and feedback strategy involving change management and improvement principles was utilized...
December 20, 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27975076/the-role-of-antimicrobial-stewardship-in-the-clinical-microbiology-laboratory-stepping-up-to-the-plate
#18
Shawn H MacVane, John M Hurst, Lisa L Steed
We report the development of a collaborative relationship between antimicrobial stewardship and clinical microbiology that incorporates stewardship practices into daily laboratory rounds. Antimicrobial stewardship involvement on rounds was a welcomed and effective initiative with substantial rates of intervention. New opportunities to positively impact use of antimicrobials and laboratory resources were realized.
October 2016: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/27934550/healthcare-resource-allocation-decisions-affecting-uninsured-services
#19
Krista Lyn Harrison, Holly A Taylor
Purpose Using the example of community access programs (CAPs), the purpose of this paper is to describe resource allocation and policy decisions related to providing health services for the uninsured in the USA and the organizational values affecting these decisions. Design/methodology/approach The study used comparative case study methodology at two geographically diverse sites. Researchers collected data from program documents, meeting observations, and interviews with program stakeholders. Findings Five resource allocation or policy decisions relevant to providing healthcare services were described at each site across three categories: designing the health plan, reacting to funding changes, and revising policies...
November 21, 2016: Journal of Health Organization and Management
https://www.readbyqxmd.com/read/27927861/what-is-the-more-effective-antibiotic-stewardship-intervention-pre-prescription-authorization-or-post-prescription-review-with-feedback
#20
Pranita D Tamma, Edina Avdic, John F Keenan, Yuan Zhao, Gobind Anand, James Cooper, Rebecca Dezube, Steven Hsu, Sara E Cosgrove
BACKGROUND: The optimal approach to conducting antibiotic stewardship interventions has not been defined. We compared days of antibiotic therapy (DOT) using pre-prescription authorization (PPA) versus post-prescription review with feedback (PPRF) strategies. METHODS: A quasi-experimental, crossover trial comparing PPA and PPRF for adult inpatients prescribed any antibiotic was conducted. For the first four months, two medicine teams were assigned to the PPA arm and the other two teams to the PPRF arm...
December 7, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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