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[논문] 항균제 관리팀에서 약사의 업무 개발 및 확대 방안(Implementation and Expectation of Pharmacist-Enhanced Antimicrobial Stewardship Program in Korea)
Date

2018년 Vol.35 No.01

Authors
김형숙a, 김송이a, 이은숙a, 김은경b, 송경호c, 김의석c, 김홍빈c(분당서울대학교병원 약제부a, 서울대학교 약학대학b, 분당서울대학교병원 감염내과c)
Keyword
Antimicrobial stewardship program, Intervention, Antimicrobial agents
Abstract

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.

Full-Text
030-038학술보고3김형숙(1).pdf