2018년 Vol.35 No.01
Background : Pharmacists are key members of the Antimicrobial Stewardship Program (ASP) team
playing a critical role in improving antimicrobial use. A pharmacy intervention program built in the
hospital electronic medical records for ASP (ASP-EMR) was developed and the sustained impact of
the pharmacist-enhanced ASP was described in this study as measured by antimicrobial use and
costs and the proportion of inappropriate antimicrobial prescriptions.
Methods : An interrupted time series with segmented regression analysis was conducted in 3
stages; 1-preintervention; 2-pharmacists’participation in ASP without ASP-EMR and 3-pharmacists’participation
in ASP with ASP-EMR. Using EMR data from a tertiary care hospital, the information
on the prescribed antimicrobial agents was extracted 2009-2016. The pharmacist-enhanced
ASP intervention started in March 2012. Prospective audit and feedback were triggered by ASP-EMR
and the program was led by 1 clinical pharmacist and 1 pharmacy resident. Changes in the outcomes were compared before and after the pharmacist intervention with or without ASP-EMR.
Results : The development of pharmacy intervention program via ASP-EMR was completed in May
2016. After the pharmacist-enhanced ASP intervention, the rate of broad spectrum antimicrobial
agents decreased as measured by daily defined doses (DDDs)/1,000 inpatient days (120.1 in Stage 1 and
103.5 in stage 3). In Stage 3, inappropriate duplication of anaerobic coverage was decreased as compared
to Stage 1 as measure by days of therapy (DOT)/length of therapy (LOT) (1.13 in Stage 1 and 1.01
in Stage 3). The intervention on the intravenous (IV)-to oral conversion of quinolones increased the
proportion of oral ciprofloxacin prescription and the estimated cost avoidance from interventions was
4,291,797 won in Stage 2 and 5,208,979 won in Stage 3.
Conclusion : The implementation of the pharmacists’participation in ASP at a tertiary care hospital
in Korea was associated with a positive impact on antimicrobial use, spending, and inappropriate prescriptions.