Transcript Initiating an Antimicrobial Stewardship Program at British

Initiating an Antimicrobial Stewardship
Program at
BC Children's Hospital
Quality Forum 2015
Ashley Roberts, MD, M.Ed, FRCP(C)
Karen Ng, BSc.Pharm, ACPR, PharmD, BCPS
February 19, 2015
Disclosures
• We have no conflicts of interest to
declare
Goals of Antimicrobial Stewardship
“to optimize clinical outcomes while minimizing
unintended consequences of antimicrobial use”
• Reduce risk of infections
• Reduce adverse drug events related to
antimicrobial use
• Reduce or stabilize antibiotic resistance
• Promote patient safety
BC Children’s Hospital
Antimicrobial Stewardship Program
• 180-bed tertiary care
academic hospital and
major referral centre for
acutely ill or injured children
• Antimicrobial Stewardship
Program implemented
September 2013
Challenges of Implementing a Pediatric
Antimicrobial Stewardship Program (ASP)
• Limited evidence vs. adult programs for ASP
implementation
• Fragilities of neonatal and pediatric
population
• Limited evidence and treatment guidelines
for pediatric infections
Pharmacother 2012;32(8):735-743.
Key #1
Collaboration
•
•
“Collective Ownership”
Promote Mutual Learning
1. Collaboration
Antimicrobial Stewardship Team at
BC Children’s and Women’s Hospital
Form an effective multidisciplinary AMS team of core
members.
ASP Member
Role
Dr. Ashley Roberts
PHSA AMS Director, Infectious Diseases Specialist
Dr. Simon Dobson
Co-chair, Infectious Diseases Specialist, Infection Preventionist
Dr. Karen Ng
Dr. Vanessa Paquette
Clinical Pharmacy Specialists
Dr. Peter Tilley
Medical Microbiologist
Dr. Srinivas Murthy
Dr. Rod Rassekh
Dr. Joseph Ting
Pediatric Intensive Care Champion
Oncology AMS Champion
Neonatal Intensive Care Champion
Dr. Roxane Carr
Pharmacy Clinical Coordinator
1. Collaboration
Antimicrobial Stewardship Team at
BC Children’s and Women’s Hospital
Form an effective multidisciplinary AMS team of core
members.
P
ARTNERSHIP WITH MICROBIOLOGY IS ESSENTIAL
ASP
Member
Role
•Dr.Antibiogram
Ashley Robertsproduction
PHSA AMS Director, Infectious Diseases Specialist
•Dr.Bacterial
susceptibilityCo-chair,
breakpoints
tailoring and antimicrobial dose
Simon Dobson
Infectious Diseases Specialist, Infection Control
optimization
Dr. Karen Ng
Clinical Pharmacy Specialists
• Microbiology reports and
comments modifications
Dr. Vanessa Paquette
• Implementation of new guidelines/initiatives
Dr. Peter Tilley
Medical Microbiologist
Dr. Srinivas Murthy
Dr. Rod Rassekh
Dr. Joseph Ting
Pediatric Intensive Care Champion
Oncology AMS Champion
Neonatal Intensive Care Champion
Dr. Roxane Carr
Pharmacy Clinical Coordinator
1. Collaboration
Antimicrobial Stewardship Team at
BC Children’s and Women’s Hospital
Form an effective multidisciplinary AMS team of core
members.
IASP
DENTIFY
Member
ASP CHAMPIONS
Role
Dr.
Ashley Roberts
AMS Director,
Infectious Diseases Specialist
Physicians
with interest inPHSA
infectious
diseases
Dr.
Simon Dobson
Co-chair,
Infectious Diseases
Specialist, Infection Control
Promotes
collaboration and
acceptance
of ASP interventions
Expands
opportunities for
research
Dr. Karen Ng
Clinical
Pharmacy Specialists
Dr. Vanessa Paquette
Dr. Peter Tilley
Medical Microbiologist
Dr. Srinivas Murthy
Dr. Rod Rassekh
Dr. Joseph Ting
Pediatric Intensive Care Champion
Oncology AMS Champion
Neonatal Intensive Care Champion
Dr. Roxane Carr
Pharmacy Clinical Coordinator
1. Collaboration
• Example: Partnership with NSQIP (National Surgical
Quality Improvement Program)
Key #2
Optimize Available
Resources
AMS Pharmacist
12
AMS Pharmacist
13
Key #2: Optimize Available Resources
Teamwork-driven daily prospective audit
and feedback
• Microbiology liaison
• Infection Control liaison
• Infectious Diseases team
• Partnership with clinical pharmacists
Key #3
Adapt Strategies to
Your Site
• Understand local culture and attitudes
• Evaluate “worst offenders”
• Establish achievable goals
Key #3: Adapt Strategies to Your Site
At BC Children’s Hospital:
Strategies Used/Adopted
Strategies Bypassed
Daily prospective audit and
feedback
Formulary restrictions
Dose optimization
Automatic stop orders
Education, development of
guidelines and order sets
Preauthorization requirements
Active surveillance
Ongoing research
Key #3: Adapt Strategies to Your Site
•Most ASPs target specific antimicrobials in audit and feedback.
•BC Children’s Hospital experience: Audit all antimicrobials
Cumulative # Interventions in 2014
0
cefotaxime/ceftriaxone
vancomycin
1st-gen cephalosporins
amoxicillin/ampicillin
aminoglycosides
piperacillin/tazobactam
metronidazole
cloxacillin
clindamycin
meropenem
acyclovir
fluconazole
ciprofloxacin
macrolides
amox/clav
voriconazole
2nd-gen cephalosporins
sulfamethoxazole-trimethoprim
Other
100
200
300
400
500
Adapting Antimicrobial Stewardship
to the Pediatric Population…
Reflections and Lessons Learnt
• Limited evidence requires greater flexibility,
discussion and collaboration
• Continual reassessment and readjustment of ASP
strategies and initiatives
• Must not forget the humanistic factor
• Data collection and analyses are crucial
“from restriction to facilitation”
Am J Health Syst Pharm 2011;68:109-10
Summary:
Keys to Success
Initiating an ASP in a Pediatric Hospital
1. Collaboration
2. Optimize available resources
3. Adapt strategies to local culture and
attitudes
Questions?
Ashley Roberts
[email protected]
Karen Ng
[email protected]
604-875-2000 ext 5952
Pager: BCCH Antimicrobial Stewardship