All Hands on Deck: Incorporation of Infectious Diseases Pharmacy Trainees in a Community Hospital Antimicrobial Stewardship Program

ABSTRACT

Background. Community hospitals may have challenges implementing core elements of antimicrobial stewardship (ASP) due to lack of ID trained pharmacists (PharmD). The COVID-19 pandemic compounded these challenges with constrained resources and staffing. The pandemic also saw a rise in antimicrobial use (AU) and brought forth novel therapeutics, thus increasing the need for robust ASP. We established a community ASP rotation for ID PharmD fellows during the COVID-19 pandemic. Methods. A community ASP rotation was established at a 151-bed community hospital. ID PharmD trainees rotated with the ID clinician and were responsible for daily prospective audit and feedback (PAF) under close supervision of the ID clinician. Fellows were involved in pandemic response, including protocol development and restrictions for COVID-19 therapeutics. Results. A community ASP rotation was successfully implemented (Figure 1). For PAF activities, the most common indications were CAP (19%), HAP (3%), IAI (24%), SSTI (22%) and UTI (19%). Average DOT/1000 was 340.4 per quarter with increases each COVID-19 surge (Figure 2). Empiric AU was protocol adherent 77% of the time and 23% required ASP changes. ASP Interventions included change to protocol (23%), bug drug mismatch (2%), de-escalation (15%), duration change (25%), IV to PO (16%), discontinuation (19%). Fellows successfully developed protocols and managed restrictions for remdesivir, baricitinib, and anti-SARS-CoV-2 monoclonal antibodies in coordination with the ID clinician and assisted in mass vaccination campaign protocols. Conclusion. A community ASP rotation was successfully established and sustained during COVID-19. Fellows received hands on experience and performed PAF under close supervision. The program enhanced ID clinician capabilities while leveraging PharmD expertise at a time when staffing and resources were stretched thin. The rotation providedfirst hand experience in pandemic preparedness and response. This educational opportunity assisted in maintaining a strong ASP in a community hospital setting while preparing trainees with experiences to assist them throughout their future careers.