Antimicrobial Stewardship

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Antimicrobial Stewardship

• A Team Approach at MRMC
• Kimberly E. Knox, RN, MHA, CIC

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Focus of Presentation

• Describing the efforts that one medical center
  made in establishing an antimicrobial stewardship
  program.
•  

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The Multidisciplinary Team

• Sue Otocki, Director of Pharmacy
• Paula Flynn, Staff Pharmacist
• Jen Schelin, Staff Pharmacist
• Pharmacy students
• Maureen Harris, Microbiology Supervisor
• Michael Newstein, MD, PhD, Infectious Disease
  Specialist
• Erin Grenier, IP
• Kim Knox, IP

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The Team Implemented

• Front end restriction
• Back end restriction
• Retrospective review of drug orders
• Formulary restrictions
• Automatic stop orders

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The Team Implemented

• ID consult required
• Verbal approval
• IV to PO switch
• Monthly review of the following antimicrobials
  per 1000 patient days at PT and IPC Committees
• Cipro
• Invanz
• Levaquin
• Zosyn

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Infectious Disease Specialist

• Attends Department of Medicine and Surgery
  meetings to share information about
• Antimicrobial stewardship
• Proton pump inhibitor use
• Posts on the MRMC Intranet
• Common Infectious Diseases and Empiric Antibiotic
  Recommendations for Adult ER and Inpatients
• Antibiogram

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Proton Pump Inhibitor (PPI) Reduction

• Recent FDA black box warning indicates that the
  use of PPI can increase an individuals risk of
  acquiring CDI
• What we are doing
• Recommendations for discontinuing therapy before
  or at the time of discharge
• Working with partnering SNFs to foster
  appropriate PPI use for their residents
• Recent review shows a reduction in patients being
  discharged from MRMC on PPIs
• Information was highlighted in the April 2012
  Pharmacy Newsletter

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C DIFF Reduction Partnership Collaborative

• Information is shared with our community SNF by
  partners at monthly meetings including
• Appropriate use of medication
• Cleaning techniques
• New technology or products
• Education for EOC staff

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SCIP

• MRMC follows recommendations for SCIP
  antimicrobial prophylaxis for surgical procedures
• IS, Nursing Informatics, Surgeons, Infectious
  Disease and IPC worked together in developing
  CPOE to be compatible with our goals

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Amerinet Healthcare Achievement Award

• May 2012
• MRMC Antibiotic Stewardship pharmacists won
• Amerinet Healthcare Achievement Award for
  Financial and Operational Improvement

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Amerinet Healthcare Achievement Award

• The program that was implemented to decrease
  Zosyn usage
• In one year, the program decreased our costs and
  usage approximately
• sixty percent!

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Cipro Doses per 1000 Patient Days
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Invanz Doses per 1000 Patient Days
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Levaquin Doses per 1000 Patient Days
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Zosyn Doses per 1000 Patient Days
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Objectives

• To highlight the importance of
• Implementing a multidisciplinary team in
  establishing an antimicrobial stewardship program
• Developing multipronged communication efforts for
  distributing information

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Thank you!