IMPLEMENTING ANTIMICROBIAL STEWARDSHIP IN A CRITICAL ACCESS HOSPITAL

Transcription

1 IMPLEMENTING ANTIMICROBIAL STEWARDSHIP IN A CRITICAL ACCESS HOSPITAL The nitty gritty of a practical approach. Cameale Johnson, PharmD MBA South Peninsula Hospital Homer, Alaska

2 What this presentation is NOT about: Rationale & goals of antimicrobial stewardship programs Justification for antimicrobial stewardship programs Core elements of an antimicrobial stewardship programs

3 You WILL implement an antimicrobial stewardship program California is the first and remains the only state to enact antimicrobial stewardship legislation Since 2008 California law required that general acute care hospitals develop a process for monitoring the judicious use of antibiotics and that the results are monitored by quality improvement committee(s).

4 In September 2014, California Senate Bill 1311 was signed into law, further requiring hospitals to adopt and implement an antimicrobial stewardship policy in accordance with guidelines established by federal government and professional organizations, and to establish a physician-supervised multidisciplinary antimicrobial stewardship committee with at least one physician or pharmacist who has undergone specific training related to stewardship.

5 Washington State Hospital Assoc October 2014, rolled out a statewide initiative requiring all hospitals to implement an antimicrobial stewardship program and requires monthly data submission to the WSHA quality benchmarking system starting in March

6 The White House

7 CMS Will propose as a condition of participation in the federal Medicare & Medicaid programs that hospitals have a robust antimicrobial stewardship program in place by then end of 2016

8 HOW will you do it? Get educated about appropriate use of abx; credibility is critical MAD-ID (Making a Difference in Infectious Disease Pharmacotherapy) online basic antimicrobial stewardship course Certification course and helps tremendously with the competency issue Not limited to pharmacists Cost

9 iphone apps Sandford Guide to Antimicrobial Therapy Johns Hopkins POC-IT ABX Guide

10 Need to develop a report listing the patients on the abx you are going to target SPH is small, we review all abx on all patients Look at the report EVERY day. Ensuring appropriateness happens with every single antibiotic order!

11 Be committed! It is not optional to not review because you are too busy. Do it first thing in the AM so you are prepared when the physicians make rounds

12 Data Collection Baseline data if you don t have anything to compare to how do you know if you are making a difference? Quantify what your antibiotic burden is.how much you use Days of Therapy (DOT) vs Defined Daily Dose (DDD) DDD if your computer system cannot calculate DOT

13 Data Denominator 1000 Pt days Need to ensure your abx usage data is from the pt population you are using for pt days SPH uses inpatient days incl swing beds because a large proportion of our total pt days are swing beds SPH does not include LTC or obs Whatever you use, be consistent so can compare apples to apples

14 Drug Costs Showing a savings can be useful for getting support for antimicrobial stewardship program SPH does not track savings because there is no efficient way to get abx costs for only inpts Comparative expenditure costs can be misleading because they do not take into consideration inflation & added costs of obtaining hard to get drugs during times of shortages Antimicrobial stewardship programs are being mandated so why bother with the labor involved in trying to track costs?

15 It is important to note antimicrobial stewardship programs will not realize savings forever. In fact, as organisms become more resistant use of more expensive agents will be required. The program s focus on prevention of resistance, adherence to published approved guidelines, and appropriate de-escalation of therapy will allow for sustained cost-avoidance at a minimum, while optimizing patient care.

16 What next? Start slowly based on your comfort level Talk face to face with the physician no notes on the chart Use non-threatening verbiage This pt has decreased renal function. Would it be ok if I adjust the abx for the renal function? This pt is taking all oral meds ok, is it ok if we switch the azithromycin to oral

17 Pt admitted on cefazolin appears to have gut issue going on You might consider switching to pip/tazo which will provide better coverage including anaerobes De-escalation after 72h Cultures are negative, wbc is normal and the pt is afebrile.would it be ok if we discontinued the vanco?

18 Trauma pt coming into the ED w open fx..to the ortho surgeon Would you like me to get a dose of cefazolin & gent ready? Pt w hx of meth use; facial sores, etc started on cefazolin for abscess This pt is high risk for MRSA, what do you think about switching to vanco

19 Pt on vanco & levo w no evidence of infection Would you please reconsider the need to continue abx Urine growing E coli & Pseudo; pt on ceftriaxone In addition to E coli, this pt is growing a pseudomonas.is it ok if we switch to levofloxacin which will cover both organisms?

20 Never use verbiage: Per policy Guidelines state.. I have always favored an educational approach to change, NOT restrictive or mandates Everybody wants to do the right thing.you just have to convince the physician what the right thing is

21 Antimicrobial Stewardship Policy & Reports The only reason SPH has a policy is to formalize the program AND to meet upcoming CMS requirements Make it simple Reports to Infection Control

22 Questions? Cameale Johnson