ASSESSING THE FEASIBILITY OF ANTIBIOTIC MANAGEMENT SERVICES THROUGH PROSPECTIVE EVALUATION

1
ASSESSING THE FEASIBILITY OF ANTIBIOTIC
MANAGEMENT SERVICES THROUGH PROSPECTIVE
EVALUATION

• ealth

• HSR

• ystems

Kevin D. Mills, Pharm D1 Corstiaan Brass, MD2
Marisa Rahn, Pharm D, BCPS3 James Fenner, B.
Sc., Pharm D, BCPS4 Salvi Parpia, B. Sc., Pharm
D, MRCF5 1Clinical Pharmacy Coordinator, Kaleida
Health/DeGraff Memorial Hospital 2Clinical
Associate Professor, SUNY at Buffalo School of
Medicine 3Assistant Professor of Pharmacy
Practice, Albany College of Pharmacy 4Clinical
Pharmacy Coordinator, Kaleida Health/Millard
Fillmore Suburban Hospital 5Clinical Assistant
Professor, Faculty of Pharmaceutical Sciences,
University of British Columbia

• enovators, LLC

METHODS
RESULTS
RESULTS

• ABSTRACT
• PURPOSE The inappropriate and unnecessary use of
  antibiotics is an important problem in the
  hospital setting. The goal of this assessment was
  to prospectively evaluate the extent of
  antibiotic misuse at a community hospital, and to
  realistically quantify the potential reduction of
  direct and indirect hospital costs if an
  antibiotic management service were employed.
• METHODS A 3-week prospective evaluation was
  performed at a 100 bed private hospital facility.
  During the evaluation period, all antibiotic use
  at the facility was captured by a
  residency-trained antibiotic streamlining
  pharmacist. Appropriateness of antibiotic therapy
  was assessed based on infection diagnosis and
  supporting evidence for the presence of active
  infection. The extent of inappropriate antibiotic
  use, as well as the potential direct and indirect
  hospital cost of non-focused antibiotic
  utilization, was estimated using a customized
  database.
• RESULTS Of a total of 149 patients who received
  antibiotic therapy during the evaluation period,
  116 were evaluated and actively followed by the
  streamliner. A total of 137 potential
  interventions were identified. Seventy-four of
  the potential interventions involved antibiotic
  change or discontinuation, while 44 involved
  change from IV to oral therapy. An estimated
  8,354 in potential drug cost savings was
  identified (144,807 annually). If an antibiotic
  management program were employed, the initial
  acceptance rate of recommendations would likely
  be around 85 percent. Thus, a realistically
  achievable estimate of drug cost savings from
  antibiotic management is 7,100 over three weeks,
  or 123,000 annually. A minimum cumulative
  reduction of 23 patient days could have been
  achieved by earlier conversion to oral therapy,
  accounting for an additional 5,750 in potential
  cost savings to the facility (99,750 annually).
• DISCUSSION The annual cost savings for the
  facility that could be achieved through focusing
  of antibiotic therapy is approximately 223,000.
  Based on the results of this observational
  evaluation, there is sufficient inappropriate and
  non-focused antibiotic use to justify the
  presence of an antibiotic management service at
  MSM. We intend to initiate an antibiotic
  management program at this facility beginning in
  2005. Once this program has been established, we
  will be able to evaluate the accuracy of our
  methods for determining the potential cost
  savings of antibiotic management services.
• INTRODUCTION
• Antimicrobial stewardship initiatives have
  consistently been associated with significant
  reductions in antibiotic use, improved bacterial
  susceptibility patterns, and reduced inpatient
  LOS of infected patients
• Many facilities continue to operate without
  such programs
• - One likely reason is the perceived lack of
  financial resources needed for the development
  and implementation of these programs
• The relationship between sub-optimal antibiotic
  use and potential cost savings to a facility has
  not been clearly established
• A valid means of prospectively evaluating the
  potential impact of antibiotic management
  initiatives would be useful

• The Facility
• Mount St Marys Hospital (MSM) is a 100 bed
  secondary care facility
• A member of the Ascension Catholic hospital
  network
• 11 bed intensive care unit
• Non-teaching facility
• At the time of this evaluation, no significant
  measures to improve cost-effectiveness of
  antibiotic therapy were employed

Antibiotic Regimen Details Over 3-week Study
Period (prescribed vs. focused)

• Evaluation dates May 3rd through May 24th, 2004
• Total No. of patients who received antibiotic
  therapy during study period 149

Patient Demographics

• Data collection and Analysis
• A prospective, observational evaluation was
  conducted at MSM over a three week period
• All antibiotic use at the facility was captured
  along with patient demographic data, details
  of infection and concomitant diagnosis, and
  relevant laboratory and culture data
• Data collection and antibiotic regimen
  assessment were performed by a residency trained
  clinical pharmacist (KM)
• Antibiotic selection, dosing, and duration of
  therapy were evaluated based on evidence-based
  practice standards and guidelines
• The definitions used when determining the
  appropriateness, redundancy, and focus of
  prescribed antibiotic regimens are stated below
• A physician specialist in infectious diseases
  (CB) was consulted for further insight into the
  appropriateness and/or focus of a given regimen
  when necessary
• Each IV antibiotic regimen was assessed daily
  for potential conversion to oral therapy based on
  the stated criteria

Potential Impact of an Antibiotic Management
Program on Antibiotic Spending

• If an antibiotic management program were
  employed, the initial acceptance rate of
  recommendations would likely be around 85
• - Thus, a realistically achievable estimate of
  drug cost savings from antibiotic management is
  7,100 over three weeks, or 123,000 annually

Potential Therapy Interventions
Estimated (minimum) LOS Impact of IV to Oral
Conversions
44 (32.1)
60 (43.8)
DISCUSSION

• The minimum expected annual cost savings for
  the facility from drug cost savings and decreased
  inpatient LOS is approx. 223,000
• The potential decrease in LOS of 23 days over 3
  weeks was meant to be a conservative estimate
• - In the literature, the impact of early IV to
  PO conversion on inpatient LOS has been
  suggested to be much greater (from 1 to 2.5 days
  per conversion)
• Limitations
• Short observation period
• Method for evaluating the prescribed antibiotic
  regimens was superficial (info. obtained
  from patient records, no direct patient
  assessment)
• Conclusion
• There is sufficient inappropriate and
  non-focused antibiotic use to justify the
  presence of an antibiotic management service at
  MSM
• Our intent is to establish an antibiotic
  management program at this facility beginning in
  2005
• Once this program has been established, we will
  be able to draw conclusions as to the accuracy of
  our methods for determining the potential cost
  savings of antibiotic management services

19 (13.9)
14 (10.2)

• Estimating potential impact on antibiotic cost
• When an antibiotic regimen was deemed
  inappropriate or non-focused, a potential
  intervention was recorded and a focused regimen
  was formulated
• Patients actual antibiotic regimen and the
  focused regimen were tracked until patient
  discharge or discontinuation of therapy
• Estimated drug cost savings Cost of
  prescribed regimen(s) - Cost of focused
  regimen(s)
• Estimating impact on inpatient length of stay
  (LOS)
• If a patient (as a result of IV to oral
  conversion) would subsequently be off all IV
  medications and had no other unresolved medical
  issues, a potential LOS decrease of 1 (one) day
  was recorded.
• Mean cost per day of inpatient stay was
  obtained from the facility

Potential Therapy Interventions (Cont.)

• All data were collected and analyzed using a
  customized Access database.
• Cost of antibiotic therapy was determined using
  purchasing data obtained from the facilitys
  Department of Pharmacy