Transcript Antibiotic Stewardship at RMH

Guidance DS – using a decision
support to improve antimicrobial
prescribing
Dr Karin Thursky
Infectious Diseases Physician and Clinical Research Fellow
Victorian Infectious Diseases Service, Royal Melbourne Hospital
[email protected]
History of DSS development at
VIDS
Web-based ceftriaxone approval system
(2000-2002)
– Sustained reduction (Richards et al, MJA, 2004)
ADVISE project (1999-2003)
– Real-time microbiology browser and
patient/isolate specific antibiotic DSS in ICU
– Intervention associated with reduction in total
and broad spectrum antibiotic use (Thursky et al,
IJHQC, 2006)
Guidance DS
Won 2006 Premiers Healthcare award for
innovations in IT
Now deployed at Petermac, Barwon and soon at
Alfred. Has won statewide tender in Tasmania
Provides a novel workflow solution for drug
stewardship (not just antimicrobials)
System has workflows for doctors, pharmacists,
infectious diseases “authorised prescribers”,
auditors, administrators
Alerts help flag inappropriate use
Retrieves patient data from
hospital PMI/pathology
Content is developed by
clinicians, using national
therapeutic guidelines
All functionality of
Internet Explorer
browser
Approvals can be tracked by
pharmacists and doctors with yellow
alerts for important infections
Total of 115 participants
80% believed that the system
Increased their knowledge about antibiotic guidelines
Decreased inappropriate antibiotic prescribing
> 70% believed that the system
Increased their adherence to evidence based medicine
Improved the communication between them and
pharmacists
About 60% believed that system was easy to use with
daily workflow
Rigorous qualitative evaluation by external reviewer (T.Zaidi)
Quality and Safety
Monitor usage trends of drugs within
Melbourne Health
– Inbuilt auditor and reporting functionality
Benchmark antimicrobial use nationally
Evaluate impact on antimicrobial resistance
patterns
Patient outcomes- impact of early
appropriate intervention?
Sustained impact
RMH now has some of the lowest usage of several
classes of antibiotics among hospitals of similar size
Ceftriaxone usage
AAS
Guidance
Jul07
May07
Mar07
Jan07
Nov06
Sep06
Jul06
May06
Mar06
ICU H
non-ICU H
Jan06
Nov05
Sep05
Jul05
May05
Mar05
Jan05
Nov04
Sep04
Jul04
DDDs / 1000 bed days
3rd/4th gen ceph use
(National Antimicrobial Surveillance)
ICU N
non-ICU N
250
200
150
100
50
0
Impact on antibiogram
Yong et al (In process)
Closing the feedback loop
Targeted audits of usage- e.g vancomycin
Non-standard indications reviewed in
antimicrobial subcommittee
Scrolling educational messages
Automated reward system for users
Letters to heads of units
Feedback to residents
Reporting capabilities- now enhanced
– can generate Crystal reports formatted for DTC
– Detailed information about indications- coding and
funding implications
Added benefits to MH
Supports S100 prescribing
Guideline support to other units
Supports complex scoring systems such
as for infliximab use
Powerful clinical data store that could be
utilised for DRG coding, MIMMS etc.