Antimicrobial stewardship ward rounds led by junior members of the healthcare team improve patient care

Reported Antimicrobial Stewardship (AMS) ward rounds and review initiatives utilise consultant microbiologists or consultant ID physicians with or without senior antimicrobial pharmacists (AMP). There is sparse evidence regarding AMS ward rounds led by more junior members of staff.

Methods

AMS ward rounds were launched on the acute medical unit at Leicester Royal Infirmary, attended by a band 7 AMP and an Infectious Diseases registrar (ST3-5). Patient details and recommendations were recorded for each patient seen and followed-up to determine if recommendations were followed and the impact on treatment duration (TD), length of stay (LOS), and 28-day readmission rate (RR).

104 patient reviews were recorded, of which 87% received at least one recommendation regarding their care (median 2, SD±1.4, Range 0-6), totalling 224 recommendations. Change of antimicrobial was advised for 35 patients (33.7%), whereas stopping antimicrobials was recommended for 18 patients (17.3%). Parenteral to enteral switch was recommended for 12.5% of patients. Although all contributions supported AMS, 41.2% also supported medicines optimisation. An alternative diagnosis was also suggested in 15 patients (14.4%).

All patients were followed-up. Ward clinicians changed treatment in line with recommendations in 70.6% of instances. There was no difference in TD, median LOS was 12-hours shorter for patients whose treatment was changed in line with recommendations, and RR was 9.5% lower for those whose treatment changed in line with recommendations.

Junior staff provide valuable input regarding patient care and optimising antimicrobial therapy. There was a trend towards shorter LOS and reduced RR.