Transcript Slide 1

Tyler Continue Care Hospital Antibiotic Stewardship Program Presentation
Dr. Richard Yates Program Director * Director of Pharmacy James Ross
CEO Stephanie Hyde MSN * CNO PeytonWindham
PROGRAM DESCRIPTION
EFFECTIVENESS OF AN ANTIBIOTIC STEWARDSHIP COMMITTEE
(ASC) ON ANTIMICROBIAL COSTS AND RESISTANCE IN A LONG
TERM ACUTE CARE HOSPITAL (LTAC).
Antibiotic stewardship programs have been shown to be effective in
reducing antibiotic utilization, costs and in reducing resistance rates in
acute care hospitals. This process includes developing a team of clinical
pharmacists, infection control personnel, and infectious disease physicians
who review antibiotic use in the hospital setting, and recommended
changes to prescribing physicians on a same-day basis.
Richard R.Yates MD , James T. Ross RPh, Kristi Williams PharmD;
Tyler Continue Care Hospital, Tyler, Texas.
Introduction: ASCs have been used in acute care hospitals to review
antimicrobial use to decrease inappropriate choice, dose and duration of antibiotic
orders. We began an ASC at a 51 bed LTAC hospital and measured the impact on
antimicrobial use and development of resistant organisms.
Methods: Meetings between an Infectious Disease (ID) physician and clinical
pharmacists were held two times a week to review all antibiotic orders on
inpatients. Candidates for intervention were identified, and recommendations were
made by the pharmacist to the ordering physician. Interventions were made within
24 hours, primarily through direct verbal communication. All recommendations
were voluntary. The ID physician would intervene if questions, disputes, or patient
safety issues occurred. Monthly antimicrobial use, C. difficile, VRE, ESBL, and
MRSA rates were followed for the calendar year 2007. Interventions began in April
2007.
Results: Total monthly antimicrobial expenditures decreased from an average of
$64,000 the three months before the ASC to $30,124 average for 2011.
Antimicrobial cost per patient day fell from $45 to $23 average for 2011.
Antimicrobial costs as a percentage of total medication cost fell from 37.5% to
25%. Linezolid cost fell from $7400 to $3600. Daptomycin utilization has been
reduced from was $7879 to $4723 but still represents a significant portion of
expenditure. Echinocandin decreased during the same period, and quinolone
costs were lower. Hospital associated resistant organisms as well as C. difficile,
VRE, and ESBL were followed during the same period.
Conclusions:
Development of an ASC proved effective in decreasing
antimicrobial expenditures in a 51 bed LTAC between April 2007and Oct of 2011.
Improvement in development of some hospital associated infections also occurred.
No significant adverse events were identified.
Clinical Implications: Decreasing antibiotic use has been shown to improve
antimicrobial resistance in multiple settings. Development of an ASC improves the
likelihood antibiotics will not be misused or overused. This results in easily
measured cost savings to the institutions. More importantly, but more difficult to
measure, is the health benefit to patients in preventing adverse events and
decreasing the rate of drug resistant organisms in the hospital.
Given the longer stays, prolonged antibiotic exposure, and potentially
higher bacterial and fungal resistance pressures an antibiotic stewardship
committee was established in 2007 at a 51-bed Long Term Acute Care
Hospital (LTACH). Anti-infective expenditures as well as the impact on
antimicrobial resistance and hospital acquired infections were measured.
Our goal was to reduce the overall antimicrobial use, encourage use of
antibiotics which induce little resistance, and shorten the overall antibiotic
exposure to patients.
The program was set up between a clinical pharmacist and Infectious
Disease (ID) physician meeting twice weekly. Patients receiving antibiotics
were evaluated and reviewed for drug selection/appropriateness, dose,
duration, renal function, and microbiology lab data. The pharmacist and ID
physician would then discuss patients that required intervention. The
pharmacist would then discuss possible changes with the prescribing
physician. All interventions were recommendations only, none were
mandatory.
The committee would follow up the recommendations, offer educational
supplements to the physicians, and keep meetings open to physicians for
discussion. The committee would met periodically with the Infection
Control Committee to monitor prescribing trends and their effect on
antibiotic resistance within the hospital. Physicians were invited to join the
committee any time with questions or concerns.
EFFECTIVENESS OF AN ANTIBIOTIC STEWARDSHIP COMMITTEE (ASC)
ON A HOSPITAL (LTAC).
Richard R.Yates MD , James T. Ross RPh, Kristi Williams PharmD;
Tyler Continue Care Hospital, Tyler, Texas.
Introduction: ASCs have been used in acute care hospitals to review
antimicrobial use to decrease inappropriate choice, dose and duration of
antibiotic orders. We began an ASC at a 51 bed LTAC hospital and measured
the impact on antimicrobial use and development of resistant organisms.
Methods: Meetings between an Infectious Disease (ID) physician and clinical
pharmacists were held two times a week to review all antibiotic orders on
inpatients. Candidates for intervention were identified, and recommendations
were made by the pharmacist to the ordering physician. Interventions were
made within 24 hours, primarily through direct verbal communication. All
recommendations were voluntary. The ID physician would intervene if questions,
disputes, or patient safety issues occurred. Monthly antimicrobial use, C.
difficile, VRE, ESBL, and MRSA rates were followed for the calendar year 2007.
Interventions began in April 2007.
Results: Total monthly antimicrobial expenditures decreased from an average
of $64,000 the three months before the ASC to $30,124 average for 2011.
Antimicrobial cost per patient day fell from $45 to $23 average for 2011.
Antimicrobial costs as a percentage of total medication cost fell from 37.5% to
25%. Linezolid cost fell from $7400 to $3600. Daptomycin utilization has been
reduced from was $7879 to $4723 but still represents a significant portion of
expenditure. Echinocandin decreased during the same period, and quinolone
costs were lower. Nosocomial acquired resistant organisms as well as C.
difficile, VRE, and ESBL were followed during the same period.
Conclusions:
Development of an ASC proved effective in decreasing
antimicrobial expenditures in a 51 bed LTAC between April 2007and Oct of
2011. Improvement in development of some nosocomial infections also
occurred. No significant adverse events were identified.
Clinical Implications: Decreasing antibiotic use has been shown to improve
antimicrobial resistance in multiple settings. Development of an ASC improves
the likelihood antibiotics will not be misused or overused. This results in easily
measured cost savings to the institutions. More importantly, but more difficult to
measure, is the health benefit to patients in preventing adverse events and
decreasing the rate of drug resistant organisms in the hospital.
RESULTS
Our antibiotic stewardship program was organized and instituted in
April 2007 following antibiotic expenditures and the impact on hospital
acquired infections. On a monthly basis we tracked total antibiotic
costs, antibiotic costs per patient day, and the impact of high cost
antibiotic therapy. In addition we tracked hospital acquired infections
with clostridium difficile colitis, vancomycin resistant entercocci
(VRE), methicillin resistant staph aureus (MRSA), and extended
spectrum beta-lactamase (ESBL) producing gram negative bacilli.
With an average length of stay of 28 days and approximately 20% of
patients receiving long term antibiotic therapy we were able to
conclude that active antibiotic stewardship can reduce costs and
more importantly decrease resistance and hospital associated
infections.
Resistance Impact
Anti-Infective Cost/Patient Day
$38.67
$25.49
$24.89
$24.07
$23.11
12
The antibiotic stewardship committee in conjunction with infection control was
following cases of hospital acquired Clostridium difficile, VRE, MRSA, and ESBL
producing organisms. We have seen a reduction in the number of cases of c.
diff., VRE and MRSA which corresponds with a decrease in antibiotic costs and
implementation of the Antibiotic Stewardship. Cases of ESBL producing
organisms have not appreciably changed it well below the 9% United States
national average.
20
11
Hospital Acquired Infections Total Number of Cases
FY
TD
20
10
20
09
20
20
20
08
$19.47
07
$45.00
$40.00
$35.00
$30.00
$25.00
$20.00
$15.00
$10.00
$5.00
$0.00
Anti-Infective Cost/Patient Day
35
30
25
Daptomycin Effect on Anti-Infective Cost
$38.67
Anti-Infective Cost/Patient Day
20
Daptomycin Cost/PPD
15
C Diff
VRE
$40.00
$35.00
$30.00
$25.49
$24.89
$25.00
$24.07
MRSA
$23.11
$19.47
ESBL
10
$20.00
$15.00
5
$10.00
$3.24
$5.00
$0.94
$0.33
$2.16
$3.24
$2.14
0
2
20
11
20
1
FY
TD
20
10
20
09
20
08
20
07
$0.00
2007
2008
2009
2010
2011