Implementation of a pharmacist-led fluoroquinolone stewardship program: Improving use within the ambulatory care setting

Objective: To describe the implementation of a pharmacist-led fluoroquinolone stewardship program within the ambulatory care setting. Setting: Butler Veterans Affairs Healthcare System. Practice description: A fluoroquinolone stewardship program, comprising academic detailing and a standardized fluoroquinolone note in the computerized record system (CPRS), was implemented to facilitate prescribing-behavior change. An academic detailer met with all primary care providers before the implementation of a fluroquinolone note that was required to be completed with each new prescription. Both components were designed to ensure that the provider considered guideline-directed treatment alternatives before prescribing a fluoroquinolone and that the provider had a discussion with the veteran regarding potential medication adverse effects and interactions. Practice innovation: The evaluation of an ambulatory care fluoroquinolone stewardship program using academic detailing, with or without a robust note in the CPRS, has not been previously described in the literature to the authors' knowledge. Evaluation: Comparisons of the mean average incidence of fluroquinolone prescribing before and after the intervention were performed using a 1-way analysis-of-variance model. In addition, a single-group generalized least-squares interrupted time series analysis was performed to estimate the impact of the intervention on the level and slope changes before and after the implementation. Results: The mean incidence of fluoroquinolone prescribing was greater in the pre-implementation period than in the postimplementation period (4.44 vs. 1.96 per 1000 population; P < 0.001). At the time of the implementation there was an immediate drop in the incidence of fluoroquinolone prescribing by 2 per 1000 population (P < 0.001). Compared with the slope before the implementation that was not statistically different from zero, the downward slope after the implementation was statistically significant with an average monthly reduction of 0.013 per 1000 population in the incidence of fluoroquinolone prescribing (P < 0.001). Conclusion: The implementation of a fluoroquinolone stewardship program sustainably decreased fluoroquinolone use and improved the quality of care received. Published by Elsevier Inc. on behalf of the American Pharmacists Association.