Encouraging Day Three Reviews via a Pharmacist-led Antimicrobial Stewardship Ward Round

Intravenous antibiotics should be reviewed at day three and a decision made whether to continue, stop, switch to oral or refer to OPAT. Clinicians struggle to undertake this review due to the demands of the daily ward round and patients are inappropriately left on broad spectrum intravenous antibiotics, which can cause harm and increase antimicrobial resistance. A pharmacist-led virtual ward round was initiated to review these patients to decrease the number of patients on broad-spectrum IV antibiotics and support regular review of these.

Patients on day three or more of intravenous antibiotics were identified using an electronic prescribing report and reviewed using an electronic antimicrobial review tool by a pharmacist on a weekly basis.

Recommendations were made via the tool and added to the patient’s electronic record and then followed up after 24 hours to review the prescription and identify whether advice had been followed.

Over eight weeks, 75 patients had their IV antibiotics reviewed by the pharmacist. 20 recommendations were made to continue, 15 to stop, 33 for IVOS and 10 for OPAT referral. After 24 hours, 80% of patients were continued, 47% were stopped, 61% of patients were switched to oral, and 40% of patients were referred to OPAT as per the recommendations.

The pharmacist-led virtual ward round appeared to have a positive impact on the reduction of IV antibiotics being continued after day three. Additionally, reviewing patients virtually allowed for more patients to be reviewed, increasing the impact of the stewardship round.