Antibiotic Stewardship

1
Antibiotic Stewardship
lt?xml version"1.0"?gtltAllQuestions /gt
lt?xml version"1.0"?gtltAllAnswers /gt
lt?xml version"1.0"?gtltSettingsgtltanswerBulletFormat
gtNumericlt/answerBulletFormatgtltanswerNowAutoInsertgt
Nolt/answerNowAutoInsertgtltanswerNowStylegtExplosionlt
/answerNowStylegtltanswerNowTextgtAnswer
Nowlt/answerNowTextgtltchartColorsgtUse PowerPoint
Color Schemelt/chartColorsgtltchartTypegtHorizontallt/c
hartTypegtltcorrectAnswerIndicatorgtCheckmarklt/correc
tAnswerIndicatorgtltcountdownAutoInsertgtNolt/countdow
nAutoInsertgtltcountdownSecondsgt10lt/countdownSeconds
gtltcountdownSoundgtTicToc.wavlt/countdownSoundgtltcount
downStylegtBoxlt/countdownStylegtltgridAutoInsertgtNolt/
gridAutoInsertgtltgridFillStylegtAnsweredlt/gridFillSt
ylegtltgridFillColorgt0,0,0lt/gridFillColorgtltgridOpaci
tygt50lt/gridOpacitygtltgridTextStylegtKeypad
lt/gridTextStylegtltinputSourcegtResponse
Deviceslt/inputSourcegtltmultipleResponseDivisorgt
of Responseslt/multipleResponseDivisorgtltparticipant
sLeaderBoardgt5lt/participantsLeaderBoardgtltpercentag
eDecimalPlacesgt0lt/percentageDecimalPlacesgtltrespons
eCounterAutoInsertgtNolt/responseCounterAutoInsertgtlt
responseCounterStylegtOvallt/responseCounterStylegtltr
esponseCounterDisplayValuegt of Votes
Receivedlt/responseCounterDisplayValuegtltinsertObjec
tUsingColorgtBluelt/insertObjectUsingColorgtltshowResu
ltsgtYeslt/showResultsgtltteamColorsgtUser
Definedlt/teamColorsgtltteamIdentificationTypegtNonelt/
teamIdentificationTypegtltteamScoringTypegtVoting
pads onlylt/teamScoringTypegtltteamScoringDecimalPlac
esgt1lt/teamScoringDecimalPlacesgtltteamIdentification
Itemgtlt/teamIdentificationItemgtltteamsLeaderBoardgt5lt
/teamsLeaderBoardgtltteamName1gtlt/teamName1gtltteamName
2gtlt/teamName2gtltteamName3gtlt/teamName3gtltteamName4gtlt/
teamName4gtltteamName5gtlt/teamName5gtltteamName6gtlt/team
Name6gtltteamName7gtlt/teamName7gtltteamName8gtlt/teamName
8gtltteamName9gtlt/teamName9gtltteamName10gtlt/teamName10gt
ltshowControlBargtSlides with Get Feedback
Objectslt/showControlBargtltdefaultCorrectPointValuegt
100lt/defaultCorrectPointValuegtltdefaultIncorrectPoi
ntValuegt0lt/defaultIncorrectPointValuegtltchartColor1
gt187,224,227lt/chartColor1gtltchartColor2gt51,51,153lt/
chartColor2gtltchartColor3gt0,153,153lt/chartColor3gtltc
hartColor4gt153,204,0lt/chartColor4gtltchartColor5gt128
,128,128lt/chartColor5gtltchartColor6gt0,0,0lt/chartCol
or6gtltchartColor7gt0,102,204lt/chartColor7gtltchartColo
r8gt204,204,255lt/chartColor8gtltchartColor9gt255,0,0lt/
chartColor9gtltchartColor10gt255,255,0lt/chartColor10gt
ltteamColor1gt187,224,227lt/teamColor1gtltteamColor2gt51
,51,153lt/teamColor2gtltteamColor3gt0,153,153lt/teamCol
or3gtltteamColor4gt153,204,0lt/teamColor4gtltteamColor5gt
128,128,128lt/teamColor5gtltteamColor6gt0,0,0lt/teamCol
or6gtltteamColor7gt0,102,204lt/teamColor7gtltteamColor8gt
204,204,255lt/teamColor8gtltteamColor9gt255,0,0lt/teamC
olor9gtltteamColor10gt255,255,0lt/teamColor10gtltdisplay
AnswerImagesDuringVotegtYeslt/displayAnswerImagesDur
ingVotegtltdisplayAnswerImagesWithResponsesgtYeslt/dis
playAnswerImagesWithResponsesgtltdisplayAnswerTextDu
ringVotegtYeslt/displayAnswerTextDuringVotegtltdisplay
AnswerTextWithResponsesgtYeslt/displayAnswerTextWith
ResponsesgtltquestionSlideIDgtlt/questionSlideIDgtltcont
rolBarStategtExpandedlt/controlBarStategtltisGridColor
KnownColorgtTruelt/isGridColorKnownColorgtltgridColorN
amegtYellowlt/gridColorNamegtltAutoRecgtlt/AutoRecgtltAuto
RecTimeIntrvlgtlt/AutoRecTimeIntrvlgtltchartVotesViewgt
Percentagelt/chartVotesViewgtlt/Settingsgt

• 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, NPSGs for decreasing MDROs
• Took recommendations to Therapeutics Committee,
  Intensivists, Hospitalists PT 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 HealthCares 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