Vol.67 No.5 September 2019
Pharmacist-driven antimicrobial stewardship activities: efficacy of pharmacist-driven antimicrobial stewardship activities and construction of a system centering on ward pharmacists
Department of pharmacy, Yokohama general hospital, 2201-5 Kurogane-cho, Aoba-ku, Yokohama, Kanagawa, Japan
Abstract
Guidelines for implementing antimicrobial stewardship programs in Japan recommend the formation of antimicrobial stewardship teams (ASTs) with the active involvement of pharmacists specially qualified in infectious diseases. Yokohama General Hospital is a medium-sized hospital with 7 wards and 300 beds. Our hospital does not have a full-time infectious disease physician. However, we started pharmacist-driven antimicrobial stewardship in 2012. Our pharmacist-driven antimicrobial stewardship to ensure appropriate antimicrobial therapy mainly involves implementation of early intervention for cases with bacteremia and severe infections, preparation of treatment protocols for some infectious diseases, performance of therapeutic drug monitoring of antimicrobial agents on protocol-based pharmaceutical care, which we called protocol-based pharmacotherapy management, and promotion of sample collection for blood culture with the cooperation of the infection control team. In addition, we have continuously trained infectious disease chemotherapy pharmacists (IDCPs) and placed them in each ward to improve the activities of the AST and antimicrobial agent time-outs (to evaluate the type of infection, antimicrobial selection, dosage, route of administration, propriety of de-escalation and duration of treatment at about 72 hours after the start of antimicrobial therapy) in the wards. In general, because the activities of the AST are limited by the number of members and the available time, it is considered that ward pharmacists establishing relationships with the attending doctors could be the key persons in antimicrobial stewardship.
Placement of IDCPs in each ward may enhance the quality antimicrobial stewardship and possibly contribute to improvements of the process indicators and outcomes. In particular, we think that the roles played by IDCPs in wards play a major role in supporting the proper use of antibiotics in the absence of infectious disease specialists.
Key word
antimicrobial stewardship, infectious disease chemotherapy pharmacist, bacteremia
Received
September 19, 2018
Accepted
March 4, 2019
Jpn. J. Chemother. 67 (5): 543-555, 2019
