PMID- 33983389
OWN - NLM
STAT- MEDLINE
DCOM- 20211029
LR  - 20211029
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 73
IP  - 8
DP  - 2021 Oct 20
TI  - Development of the Three Antimicrobial Stewardship E's (TASE) Framework and 
      Association Between Stewardship Interventions and Intended Results Analysis to 
      Identify Key Facility-Specific Interventions and Strategies for Successful 
      Antimicrobial Stewardship.
PG  - 1397-1403
LID - 10.1093/cid/ciab430 [doi]
AB  - BACKGROUND: Successful antimicrobial stewardship (AS) interventions have been 
      described previously. Currently, a uniform operational approach to planning and 
      implementing successful AS interventions does not exist. From 2015 to 2019, 
      concomitant vancomycin and piperacillin-tazobactam use (CVPTU) for >48 hours at 
      Vanderbilt University Medical Center (VUMC) significantly decreased through AS 
      efforts. We analyzed the interventions that led to this change and created a 
      model to inform future intervention planning and development. METHODS: Adult 
      admissions at VUMC from January 2015 to August 2019 were evaluated for CVPTU. The 
      percentage of admissions receiving CVPTU for >48 hours, the primary outcome, was 
      evaluated using statistical process control charts. We created the Three 
      Antimicrobial Stewardship E's (TASE) framework and Association between 
      Stewardship Interventions and Intended Results (ASIR) analysis to assess 
      potential intensity and impact of interventions associated with successful change 
      during this time period and to identify guiding principles for development of 
      future initiatives. RESULTS: The mean percentage of admissions receiving CVPTU 
      per month declined from 4.2% to 0.7%. Over 8 time periods, we identified 4 
      periods with high, 3 with moderate, and 1 with low intervention intensity. 
      Continuous provider-level AS education was present throughout. Creation and 
      dissemination of division and department algorithms and reinforcement via 
      computerized provider order entry sets preceded the largest reduction in CVPTU 
      and sustained prescribing practice changes. CONCLUSIONS: The TASE framework and 
      ASIR analysis successfully identified pivotal interventions and strategies needed 
      to effect and sustain change at VUMC. Further research is needed to validate the 
      effectiveness of this framework as a stewardship intervention planning tool at 
      our institution and others.
CI  - (c) The Author(s) 2021. Published by Oxford University Press for the Infectious 
      Diseases Society of America. All rights reserved. For permissions, e-mail: 
      journals.permissions@oup.com.
FAU - Kimball, Joanna M
AU  - Kimball JM
AUID- ORCID: 0000-0001-6020-8047
AD  - Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, 
      Tennessee, USA.
FAU - Deri, Connor R
AU  - Deri CR
AD  - Antimicrobial Stewardship and Pharmacy, Vanderbilt University Medical Center, 
      Nashville, Tennessee, USA.
FAU - Nesbitt, Whitney J
AU  - Nesbitt WJ
AD  - Antimicrobial Stewardship and Pharmacy, Vanderbilt University Medical Center, 
      Nashville, Tennessee, USA.
FAU - Nelson, George E
AU  - Nelson GE
AD  - Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, 
      Tennessee, USA.
FAU - Staub, Milner B
AU  - Staub MB
AD  - Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, 
      Tennessee, USA.
AD  - Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare 
      System, Nashville, Tennessee, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Anti-Bacterial Agents)
RN  - 157044-21-8 (Piperacillin, Tazobactam Drug Combination)
RN  - 6Q205EH1VU (Vancomycin)
SB  - IM
MH  - Adult
MH  - Anti-Bacterial Agents/therapeutic use
MH  - *Antimicrobial Stewardship
MH  - Hospitalization
MH  - Humans
MH  - Piperacillin, Tazobactam Drug Combination
MH  - Vancomycin
OTO - NOTNLM
OT  - antimicrobial stewardship
OT  - antimicrobial stewardship framework
OT  - antimicrobial stewardship intervention
OT  - quality improvement
EDAT- 2021/05/14 06:00
MHDA- 2021/10/30 06:00
CRDT- 2021/05/13 12:34
PHST- 2021/02/03 00:00 [received]
PHST- 2021/05/14 06:00 [pubmed]
PHST- 2021/10/30 06:00 [medline]
PHST- 2021/05/13 12:34 [entrez]
AID - 6275287 [pii]
AID - 10.1093/cid/ciab430 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2021 Oct 20;73(8):1397-1403. doi: 10.1093/cid/ciab430.