Transcript Antimicrobial Stewardship: A Team Approach at Milford Regional

A Team Approach at MRMC
Kimberly E. Knox, RN, MHA, CIC
Focus of Presentation
Describing the efforts that one medical
center made in establishing an
antimicrobial stewardship program.
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
The Team Implemented:
 Front end restriction
 Back end restriction
 Retrospective review of drug orders
 Formulary restrictions
 Automatic stop orders
The Team Implemented:
 ID consult required
 Verbal approval
 IV to PO switch
 Monthly review of the following antimicrobials per 1000
patient days at P&T and IP&C Committees:
 Cipro
 Invanz
 Levaquin
 Zosyn
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
Proton Pump Inhibitor (PPI) Reduction
Recent FDA black box warning indicates that the use of
PPI can increase an individual’s 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
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
SCIP
 MRMC follows recommendations for
SCIP antimicrobial prophylaxis for
surgical procedures
 IS, Nursing Informatics, Surgeons,
Infectious Disease and IP&C worked
together in developing CPOE to be
compatible with our goals
Amerinet Healthcare Achievement Award
May 2012
MRMC Antibiotic Stewardship
pharmacists won
Amerinet Healthcare Achievement
Award for Financial and
Operational Improvement
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!
Cipro Doses per 1000 Patient Days
Cipro Doses per 1000 Patient Days
100
90
80
70
60
50
Cipro Doses per 1000 Patient Days
40
30
20
10
0
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12 May-12
Invanz Doses per 1000 Patient Days
Invanz Doses per 1000 Patient Days
50
45
40
35
30
25
Invanz Doses per 1000 Patient Days
20
15
10
5
0
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Levaquin Doses per 1000 Patient Days
Levaquin Doses per 1000 Patient Days
120
100
80
Levaquin Doses per 1000 Patient Days
60
Linear (Levaquin Doses per 1000
Patient Days)
40
20
0
Mar-11
May-11
Jul-11
Sep-11
Nov-11
Jan-12
Mar-12
May-12
Zosyn Doses per
Zosyn Doses per
1000 Patient Days
1000 Patient Days
300
250
200
Zosyn Doses per
1000 Patient Days
150
Linear (Zosyn Doses per
Patient Days)
100
50
0
Nov-10 Jan-11 Mar-11 May-11 Jul-11
Sep-11 Nov-11 Jan-12 Mar-12 May-12
1000
Objectives
To highlight the importance of:
•Implementing a multidisciplinary
team in establishing an
antimicrobial stewardship program
•Developing multipronged
communication efforts for
distributing information
Thank you!