Impact of an Antibiotic Stewardship Program in a Community Hospital

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Impact of an Antibiotic Stewardship Program in
a Community Hospital

• Katie Burenheide, MS, PharmD, BCPS
• Pharmacy Clinical Manager/Trauma Pharmacist
• Stormont-Vail HealthCare Topeka, KS

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What is Antibiotic Stewardship? Institutional
program which promotes and monitors appropriate
selection, dosing, route and duration of
antimicrobial therapy.

• Primary Goals
• Optimized clinical outcomes
• Minimize unattended consequences of antimicrobial
  use
• Toxicity
• Selection of pathogenic organisms (Clostridium
  difficile)
• Emergence of resistance
• Endorsed by multiple national organizations
• Infectious Disease Society of America
• Society of HealthCare Epidemiology of America
• American Society of Health-Systems Pharmacists
• American Academy of Pediatrics
• Society for Hospital Medicine
• Pediatric Infectious Disease Society
• Society of Infectious Disease Pharmacist
• Infectious Disease Society for Obstetrics and
  Gynecology

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SVHC Goals

• Improve patient outcomes by improving the overall
  quality of antimicrobial prescribing while
  minimizing unintended consequences of
  antimicrobial use.
• Prevent the emergence of resistant organisms by
  preventing unnecessary and/or inappropriate
  antimicrobial use.
• Reduce drug expenditures associated with
  inappropriate antibiotic use without adversely
  impacting quality of care.
• Start program in the acute care facility and
  expand to the outpatient settings as appropriate.
  

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Methods
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Antibiotic Stewardship 9 month Results
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Continued
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What Next?
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Epic May 2011CPOM July 2012

• Limited report functions
• Scorecard/Patient list improvements

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Pharmacy Automatic Protocols

• Vancomycin/aminoglycoside protocol Adult
• Pediatric in development
• Pharmacist De-escalation
• 48 hour review
• Pharmacy automatic procalcitonin protocol for
  lower respiratory tract infections

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CMS Standards

• SCIP
• Pneumonia

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New Lab Test

• PNA Fish
• Blood Cultures
• Educate staff
• De-escalation

• PCR
• Clostridium Difficile
• Educate staff
• Reviewing patient profiles
• Antibiotic coverage
• Proton pump inhibitor

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Vaccines

• Adacel
• gt20 weeks pregnancy
• Cocooning program
• Vaccine educational program
• Pediatric vaccine program (VFC)

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MRSA/VRE Antibiotic Criteria

• Protocol developed for appropriate use of
  Cubicin, Teflaro and Zyvox.
• FDA approved indications
• Reviewed after 48 hours to determine if can
  de-escalate

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Failure, Mode Effects Analysis

• Total Hip Replacement Infection Reduction

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Urinary Tract Infections

• Complicated vs. Uncomplicated Management
• Asymptomatic vs. Symptomatic
• Determine antibiotic duration
• Foley Catheter indication
• Have to list why foley catheter placed

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Antibiotic Stewardship Infection Control
Software

• Theradoc
• Helps data mind the information

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Ongoing Education

• Nursing Staff
• Nurse pharmacy liaison
• Physicians
• Pharmacist
• Pharmacy students
• Community

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Conclusion

• Antibiotic stewardship program has improved
  antimicrobial management throughout the
  organization.
• Healthcare team approach is vital for a
  successful ASP!

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Acknowledgements