December 08, 2020
In an exclusive discussion during ASHP Midyear 2020, Kelly Bach, PharmD, assistant professor, Albany College of Pharmacy and Health Sciences, explains the benefits of an antimicrobial stewardship program, and why pharmacists using these programs not only benefit patients clinically, but also financially.
My name is Kelly Bach. I'm an Assistant Professor of Albany College of Pharmacy and Health Sciences, and my practice site is Ellis Hospital in Synecdoche, New York. Our project was on impact of the antimicrobial stewardship program on pharmaceutical costs.
The reason we did this is we started our antimicrobial stewardship program back in 2015, 2016, becoming full‑time in 2016. We wanted to see the impact on this program, and does it actually have an impact on costs for our direct patient care.
As we know, the Joint Commission basically has standards that acute cute hospitals have to have antimicrobial steward program as a requirement for accreditation. We know out in the literature that it shows that approximately 22 to 36 percent decrease in antimicrobial pharmacy use.
This is wondering, OK, we know this, but how much does the dollars mean to support the justification to our leadership at the institution that this important, and this is why it's important, just besides accreditation.
We already presented previously at the institution clinical impact on patient care, but we want to see for our actual financial implications. We looked at it retrospectively of our data from our purchase information.
Pre‑intervention was January 1st of 2014 to December 31st, 2014, which was prior to our antimicrobial stewardship implementation. Then we chose January 1st of 2017 to December 31st of 2017 because this is after our full implementation with a full‑time pharmacist dedicated to antimicrobial stewardship.
We took our list of antimicrobials listed from the Centers for Disease Control and Prevention for reporting the National Healthcare Safety Network to attain which ones we were going to look at specifically. Then we excluded any antimicrobials not purchased in 2014.
There were some new ones that came out in the market, and we wanted to do a fair cost comparison before and afterwards. One of the things that we were surprised it was slightly less than what we would see, based on the literature, but we thought a significant impact is that it had savings of $108,000, so about a 10% decrease.
This is important, we thought, overall, because this helps to support the justification of pharmacists doing this type of benefit, just besides the clinical benefit to our patients. We have all of our antimicrobials listed that we used, and then we looked also, too, to see if there was a difference between ID providers for our cost comparison.
As we saw, most, there was a large decrease with our antimicrobials when we had an infectious disease physician that had to approve these antibiotics, so that was good. We also did see a similar pattern, mostly for looking by month. We thought it should be consistent.
There was a few times where it was the opposite. We're not 100 percent sure why on that aspect, so we did see a significant cost savings and a slight decrease in the antimicrobials purchased. What we're hoping to do this is looking to see do we need to focus on anything? Is there changes that we can do or implement?
This gave us at least a baseline to see, and we're hoping to see a similar decrease over time. This does help to justify if you're a new institution who is starting an antimicrobial stewardship program or doesn't have a pharmacist doing this.
This, at least, can help to bring this to the upper leadership of why this is important to have a dedicated individual to do this.
Bach K, St John T. Impact of an antimicrobial stewardship program on pharmaceutical costs (Abstract P-86). ASHP Midyear 2020. December 7, 2020.