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Antibiotic Stewardship

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Antibiotic Stewardship

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  1. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>0,0,0</gridFillColor><gridOpacity>50%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Blue</insertObjectUsingColor><showResults>Yes</showResults><teamColors>User Defined</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>Slides with Get Feedback Objects</showControlBar><defaultCorrectPointValue>100</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName><AutoRec></AutoRec><AutoRecTimeIntrvl></AutoRecTimeIntrvl><chartVotesView>Percentage</chartVotesView></Settings> <?xml version="1.0"?><AllAnswers /> Antibiotic Stewardship Agnesian HealthCare Fond du Lac, WI Wendy Bollen Fuchs, Pharm.D., M.S. Chair Antimicrobial Stewardship Committee Kayla Ericksen, BSN, R.N. Infection Preventionist, Committee Member Antimicrobial Stewardship Committee Katie Reinke, Pharm.D. Committee Member Antimicrobial Stewardship Committee

  2. What is Antibiotic Stewardship? IDSA Guidelines: Antibiotic Stewardship is an activity that promotes: The appropriate selection of antimicrobials The appropriate dosing of antimicrobials The appropriate route and duration of antimicrobial therapy

  3. The Primary Goal of Antibiotic Stewardship • The primary goal of antibiotic stewardship is to: • Optimize clinical outcomes while minimizing unintended consequences of antimicrobial use • Unintended consequences include the following: • Toxicity • The selection of pathogenic organisms such a Clostridium difficile • The emergence of resistant pathogens

  4. Other Aspects of Antibiotic Stewardship • The appropriate use of antimicrobials is an essential part of patient safety • The combination of antimicrobial stewardship and comprehensive infection prevention and control has been shown to limit the emergence and transmission of antimicrobial resistant bacteria • The frequency of inappropriate antimicrobial use is often related to antimicrobial resistance

  5. Secondary Goal of Antibiotic Stewardship • To reduce healthcare costs without adversely impacting the quality of care

  6. Antibiotic Stewardship Program (ASP) Core Strategy • Formulary restriction & preauthorization (ie. Front-end or prior authorization) • Effectiveness depends on clinician making recommendations. • Most effective method of controlling antimicrobial use. • Prospective audit with intervention & feedback (Back-end program). • MD prescribes antimicrobial pending microbiolgy results. • ASP team member reviews microbiolgy results, patient history & patient antimicrobial regimen. • Prevents therapy delays. • Effective method of controlling antimicrobial use.

  7. Core Members of the Antibiotic Stewardship Team (Recommended) • Infectious disease physician – Director or Co-director. • Clinical pharmacist with infectious disease training – Co-director or core member. • Other members of the team: • Infection prevention/control professional • Microbiologist • Information system specialist • Hospital epidemiologist

  8. How Did Agnesian HealthCare Get Started? • Infection Prevention, Director of Pharmacy discussed that a program needed to be put into place, NPSG’s for decreasing MDRO’s • Took recommendations to Therapeutics Committee, Intensivists, Hospitalists & P&T members recommended a subcommittee be formed. Hospitalist volunteered to be physician chair

  9. How Did Agnesian HealthCare Get Started? • Had preliminary meeting discussing who to include on committee. • Brainstormed-wanted a good representation from hospital i.e., ER, ICU, Surgery, Lab, Hospitalists & Waupun Physicians • Had to deviate from recommended committee members.

  10. How Did Agnesian HealthCare Get Started • Initial meeting to develop agenda • Pharmacy, Infection Prevention • Reviewed guidelines and recommendations that had been published • Included in initial meeting packet for discussion

  11. How Did Agnesian HealthCare Get Started? • The First Meeting • Committee members included: Physicians-Hospitalist, Intensivist, Surgeon, ED Director, Family Practice, Pathologist, Chair of Therapeutics Committee, Director of Pharmacy, Clinical Pharmacist with a specialty in microbiology, Infection Preventionist • Importance of Antibiotic Stewardship (ASP) – The JC (NPSG), CDC, American Society of Health Systems Pharmacists

  12. How Did Agnesian HealthCare Get Started? • Reviewed recommendations for creation of successful Antibiotic Stewardship • Assessed AHC needs and adapted recommendations to our healthcare organization

  13. How Did Agnesian HealthCare Get Started? • Listed Strategies or Criteria for Antibiotic Stewardship • IV to PO • Renal Dosing • Pharmacokinetics • Dose optimization • De-escalation • Guidelines, Clinical Pathways, Order Sets

  14. How Did Agnesian HealthCare Get Started? Supplemental Strategies • Computer-based surveillance systems • Theradoc, Sentry-7, own systems? • Clinical Microbiology Laboratory • Antibiograms • Resistance surveillance • Antimicrobial Formulary • Educate physicians, pharmacists, clinical staff

  15. How Agnesian HealthCare Get Started? • Started with Empiric Antibiotic Guidelines for Major Disease States. • Abdominal infection, cellultis, meningitis, CAP, HAP, Sepsis. • Each committee member volunteered to research disease state & the associated empiric antibiotic therapy. • Based on IDSA Guidelines.

  16. Empiric Antibiotic Therapy for Adults Reference

  17. How Agnesian HealthCare Got Started? • Placed organization of the Antibiotic Stewardship committee in plan for NPSG 07.03.01 Preventing MDRO Infections • JC Surveyors November 2010 • Plan updated with committee processes • Listen jointly to web conferences that speak to Antibiotic Stewardship (Pharmacy, Infection Prevention, Physician/s)

  18. How to Measure Success? • Antibiogram information • Surveillance for Drug resistant organism infections • SCIP measures and other quality indicator compliance • Agenda item for Therapeutics

  19. How to Measure Success? • Monitor Cost per Therapy Day • IV to PO switches • Computer Surveillance Software • Provides easier way to track interventions & cost savings.

  20. Keys to Agnesian HealthCare’s Success • Administration Support • Physician Champions • Pharmacy Clinician with Microbiology background • Team approach • Pharmacy Chairperson, Infection Preventionist, • Pharmacy administrative assistant – Agendas, Meeting Dates organization

  21. Future • Changed committee name to Antimicrobial Stewardship • Pediatric Empiric Recommendations • Community partnership with Public Health • Additional departments ad hoc such as Quality and Information Technology • Antimicrobial Pharmacy Consult Service • Expanding preventative disease practices

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