Use of an online learning module to enhance clinical pharmacist contributions to antimicrobial stewardship.

Abstract

Background: For health services without access to electronic approval systems for restricted antimicrobials, clinical pharmacists can be used to notify Antimicrobial Stewardship (AMS) teams of restricted antimicrobial prescribing. To facilitate effective AMS team triage of patients, notifications should include the drug, indication, and an assessment of appropriateness of therapy, however the latter relies on the clinical knowledge of the pharmacist. Description: At a regional health service using the aforementioned pharmacist notification system, concordance between the AMS and clinical pharmacists' assessment of appropriateness of antimicrobial therapy for respiratory tract infections (RTIs) was estimated to be below 50 percent. Didactic teaching sessions failed to increase agreement between the AMS and clinical pharmacists' assessment. Action: An anonymous, self-paced, online learning module was developed using case studies incorporating RTIs commonly associated with incorrect pharmacist assessment of antimicrobial therapy. Instant feedback was provided for the answers submitted. To investigate the module's effectiveness, a random sample of 30 notifications for RTIs submitted in the three months pre-and post-intervention were reviewed by the AMS pharmacist (using the National Antimicrobial Prescribing Survey criteria). Evaluation: 54% of clinical pharmacy staff completed the module. The percentage of correct responses per case ranged from 33 to 91%, consistent with the diversity of clinical experience within the department. Prior to introduction of the module, concordance between the AMC and clinical pharmacist's assessment was 43.3%, increasing to 73.3% (p<0.05) in the post-intervention period. The proportion of patients notified to the AMS team suffering from RTIs included in the case studies in each 3-month period was not statistically significant. Implications: the described module is an effective method of improving pharmacists' identification of appropriate antibiotic therapy for RTIs, regardless of baseline knowledge. Similar modules should be considered for other identified AMS gaps, to strengthen clinical pharmacists' knowledge and promote accurately targeted AMS team interventions.