AMS TOC Efforts at Henry Ford Health System

Antimicrobial stewardship (AMS) efforts to improve the use of antimicrobial agents is a responsibility of all clinicians. Health care institutions are required to improve the use of antimicrobial agents. Such efforts should include those which improve antimicrobial resistance and clinical outcomes for patients. AMS interventions to improve AMR have focused on patients admitted to the hospital and less on TOC or outpatient settings. Recent published TOC practices include efforts to improve discharge prescriptions by having a pharmacist review them prior to discharge.

In November 2018, HFHS expanded AMS TOC efforts to improve prescribing of oral antimicrobial therapy for discharge. This program aimed to decrease unnecessary and inappropriate antimicrobial exposure by optimizing antibiotic therapy for the following infections:

  • Uncomplicated skin & soft tissue (cellulitis, cutaneous, abscess & wound)
  • Respiratory (community acquired pneumonia, hospital acquired pneumonia, acute exacerbation of chronic obstructive pulmonary disease & influenza)
  • Urinary tract (cystitis, complicated urinary tract infection, catheter-associated urinary tract infection and pyelonephritis)
  • Intra-abdominal (spontaneous bacterial peritonitis and complicated with achieved source control)
References:
Craynon R, Hager DR, Reed M, et al. Prospective daily review of discharge medications by pharmacists: Effects on measures of safety and efficiency Am J Health-Syst Pharm. 2018; 75:e538-44.
Cesarz JL, Steffenhagen AL, Svenson J., et al. Emergency Department Discharge Prescription Interventions by Emergency Medicine Pharmacists. Ann Emerg Med. 2013;61:209-214.

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