Embracing Handshake Stewardship: Utility of Collaborative, Prospective Audit and Feedback Rounds in an Intensive Care Unit at Royal University Hospital, Saskatoon, Saskatchewan

BACKGROUND: Up to 50% of antimicrobial use in hospitals has been shown to be inappropriate and is associated with the development of antimicrobial resistance, prolonged hospital stay, as well as increased rates of Clostridium difficile infection and patient mortality. Prospective audit and feedback is a core strategy of antimicrobial stewardship programs (ASP) with relevance in intensive care units given large volumes of antimicrobial use and higher proportion of broad-spectrum antimicrobial usage. Introduction of collaborative, prospective audit and feedback rounds as part of a novel antimicrobial stewardship program can be used to optimize antimicrobial usage and quality of patient care. METHODS: Collaborative, prospective audit and feedback rounds were performed three times per week in a 17-bed intensive care unit at Royal University Hospital, Saskatoon, Saskatchewan. Antimicrobial utilization was collected in monthly intervals during baseline and intervention periods and reported in daily defined doses per thousand patient days; antimicrobials were categorized on a five-point ordinal scale according to agent spectrum. ASP recommendations were recorded prospectively in themed categories. An anonymous survey of intensivists was also performed to determine their attitudes and perceptions towards ASP. RESULTS: One hundred seventy-eight patients were reviewed by ASP during a five-month intervention period. The most common recommendations included duration optimization (27.7%), de-escalation of therapy (25.9%) and discontinuation of therapy (17.0%), with an overall acceptance rate of 92.0%. While there was no significant change in overall antimicrobial usage, broad-spectrum antimicrobial usage decreased by 28.6% (P = 0.05) and narrow-spectrum antimicrobial usage increased by 50.0% (P < 0.001). Implementation of collaborative, prospective audit and feedback rounds was widely accepted amongst intensivists as an effective strategy to improve quality of patient care. CONCLUSION: Collaborative, prospective audit and feedback rounds are an effective ASP strategy that encourages bi-directional exchange of information and education to optimize antimicrobial usage in an intensive care unit. DISCLOSURES: All authors: No reported disclosures.