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How to Start an Antimicrobial Stewardship Program

How to Start an Antimicrobial Stewardship Program. In Conjunction with AzHHA’s Safe and Sound Patient Safety Initiative Patty Gray RN, CIC & Bill Wightkin, Pharm D, R.Ph. Learning Objectives.

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How to Start an Antimicrobial Stewardship Program

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  1. How to Start an Antimicrobial Stewardship Program In Conjunction with AzHHA’s Safe and Sound Patient Safety Initiative Patty Gray RN, CIC & Bill Wightkin, Pharm D, R.Ph

  2. Learning Objectives • After listening to the presentation, viewing Power Point slides and participating in a question and answer session, the participant will: • A. Be able to list the recommended components of an antibiotic • stewardship program • B. Be able to detect antibiotic use improvement opportunities • from the analysis of utilization data • C. Be able to explain the barriers for successful • implementation of such a program

  3. Presentation Outline • I. Why Develop an Antimicrobial Stewardship Program? • A. Infection control nurse’s perspective • B. Hospital pharmacist’s perspective • II. Recommended Components of a Program • III. Scottsdale Healthcare’s Program • A. Short history • B. Committee membership and leadership • C. Goals of the committee • D. Activities-to-date • E. Results so far • F. Opportunities for improvement • G. Next steps • IV. Audience questions and answers

  4. Why Develop an Antimicrobial Stewardship Program • From an Infection Preventionist Perspective: • Track and Reduce antimicrobial resistance • Encourage appropriate treatment patterns ~ The right antibiotic, for the right duration • Develop a collaborative practice between MDs/LIPs, Pharmacy, Laboratorians and Infection Preventionists’ with best patient outcome in mind • Education Catalyst

  5. Why Develop an Antimicrobial Stewardship Program? • Hospital Pharmacist’s Perspective: • Allows needed FOCUS on a drug class • Need to assure appropriate medication management and safety • Assist with educational efforts • Assist with formulary standardization • Control costs

  6. Antimicrobial Purchases Expense of Top 100 Drugs: $17.5 million/yr Antimicrobials = $5 million/yr 29%

  7. Recommended Components of an Antimicrobial Stewardship Program • Foundation = 2 core, proactive strategies • Prospective audit with intervention and feedback • Formulary restriction and preauthorization

  8. Other Recommended Components of an Antimicrobial Stewardship Program • Standardized order sets and clinical pathways (foster evidence-based prescribing) • Antimicrobial order forms • De-escalation of therapy (Review C&S results; on-going review of therapy) • Dose optimization (right dose for site of infection; renal dose adjustment) • IV to oral dose conversion

  9. Scottsdale Healthcare’s Program: History • Evolution from an Antibiotic Subcommittee of the P&T Committee • Perception of an Antibiotic Restriction and Control Approach • Acknowledgement of Hospital and Community considerations • Need for Administrative and Board Support • Mission Development ~ Educational/Cooperative Focus~ Stewardship • University of Kentucky Program- Dr. R. Rapp • New Hospital with need for guidelines upon opening of facility

  10. SHC Program~ Committee Membership and Leadership • Medical Staff- Active participation is critical to success Includes Chief Medical Officer support, ID , Hospitalists, Intensivists, Pulmonary, ED, Community MDs and others as willing • Pharmacy- Coordinates the efforts of the team, guideline development, education and tracking reports • Infection Prevention & Control- Prevention Strategies, hand hygiene, precautions, medical staff-nursing laison • Microbiology- Data trends, special testing expertise • Quality & Organizational Development- Performance Improvement guidance; meeting guidance

  11. Goals of Committee • Assist providers in appropriate use of antimicrobial therapy with improved patient outcomes • Slow the development of antimicrobial resistance • Develop evidence- based appropriate use guidelines • Educate providers and staff regarding guidelines • Track resistance patterns and report back to medical and hospital staff • Report committee progress and outcomes to P&T, and Executive Committees

  12. Activities to Date • Developed guidelines for 4 antimicrobials • Day 7 of therapy reminder to chart • Day 10 of therapy phone call from pharmacy ID resident • Drug utilization evaluation (DUE)

  13. Results so far (2 months of data)

  14. Opportunities for Improvement • DUE reveals significant non-conformance to adopted guidelines • Are guidelines appropriate? • It does not appear that ID physicians are sufficiently • engaged in the stewardship activities • Stewardship Foundation = 2 core, proactive strategies • Is our process ROBUST (interventions after 7-10 days)??

  15. Barriers & Opportunities for Improvement • Cultural Perceptions- Medicine’s Heirarchy • Integration of Team Approach and Evidenced Based Practice into culture • Continued Involvement of Hospitalists & Community MDs • Infectious Disease MDs support, agreement & use of guidelines • Turnover of Pharmacy Leadership • Ongoing Administrative Support

  16. Next Steps • Re-evaluate physician leadership • Formulary evaluation: caspofungin vs. micafungin vs. anidulafungin • Transition from faculty ID pharmacist leadership to • SHC pharmacy clinical staff • 4. Explore expansion of pharmacist clinical duties to include • antimicrobial stewardship responsibilities • 5. Improvement of the 2 core proactive strategies

  17. Next Steps • ASK WHY…...determine and address prime causative factors that have resulted in: • Antibiotic overuse • Sub-optimal antibiotic selection • Too long duration of therapy • Lack of de-escalation to more appropriate agents • Slow switch to oral therapy • Marketing pressure? • Education-Training-Competency? • Workload issues with poor attention to detail? • Insufficient pharmacy involvement?

  18. http://id2.wustl.edu/~casabar/downloads/antibioticstewardship08.pdfhttp://id2.wustl.edu/~casabar/downloads/antibioticstewardship08.pdf

  19. References • Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of America • and the Society for Healthcare Epidemiology of America guidelines for • developing an institutional program to enhance antimicrobial stewardship. • Clin Infect Dis. 44 (1): 159-177, 2007. • McQuillen DP, Petrak RM, Wasserman RB, et al. The value of infectious disease specialists: Non-patient care activities. Clin Infect Dis. 47:1051-1063, 2008. • Spellberg B, Guidos R, Gilbert D, et al. The epidemic of antibiotic-resistant • infections: A call to action for the medical community from the Infectious • Diseases Society of America. Clin Infect Dis. 46 (2): 155-164, 2008.

  20. Antimicrobial Stewardship • QUESTIONS?

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