Building Antimicrobial Stewardship and Engaging Prescribers

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This presentation was delivered in session F1 of Quality Forum 2014 by:

Victor Leung
Infection Prevention & Control Physician
Providence Health Care
Clinical Assistant Professor, Pathology and Laboratory Medicine
UBC

Published in: Health & Medicine
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Building Antimicrobial Stewardship and Engaging Prescribers

  1. 1. Building an antimicrobial stewardship program by engaging prescribers Dr. Victor Leung, MD FRCPC
  2. 2. SEX AND THE SUPERBUG The rise of drug-resistant gonorrhea. BY JEROME GROOPMAN
  3. 3. CONSEQUENCES OF INAPPROPRIATE ANTIBIOTIC USE
  4. 4. We have an opportunity to delay the postantibiotic era and optimize patient outcomes by improving antibiotic prescribing behavior
  5. 5. PROPHYLACTIC EMPIRIC PATHOGEGN DIRECTED SUSCEPTIBILITY GUIDED
  6. 6. Systematic and coordinated approach to selecting antimicrobials to achieve optimal outcomes Diagnostic test utilization Data collection + analysis Research Stewardship Infrastructure Collaboratio n with prescribers Academic Detailing Education Optimize Antimicrobial Use Formulary restrictions
  7. 7. PRIMARY DRIVERS OF INAPPROPRIATE ANTIMICROBIAL USE Indiscriminate laboratory testing Knowledge gaps Inappropriate Antimicrobial Use Inadequate documentation and transitions in care Diagnostic Uncertainty or Fear
  8. 8. Systematic and coordinated approach to using appropriate antimicrobial agents to achieve optimal outcomes Diagnostic test utilization Data collection + analysis Collaboration with prescribers Academic Detailing Education Stewardship Infrastructure Optimize Antimicrobial Use Formulary restrictions
  9. 9. Educational Journal Club Events Reached over 100 Prescribers
  10. 10. Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes Diagnostic test utilization Data collection + analysis Collaboration with prescribers Academic Detailing Education Stewardship Infrastructure Optimize Antimicrobial Use Formulary restrictions
  11. 11. Academic detailing offers point-of-care education • Microbiologic data • Local resistance patterns • Evidence based guidelines • Potential errors: • Broad spectrum • Dosing • medication interactions • allergies
  12. 12. Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes Diagnostic test utilization Data collection + analysis Collaboration with prescribers Academic Detailing Education Stewardship Infrastructure Optimize Antimicrobial Use Formulary restrictions
  13. 13. Urine Cultures from PHC Residential Care Facilities are Decreasing 300 250 Number of Urine Cutlures 200 2009 2010 150 2011 2012 100 2013 50 0 BF HFH Youville Residential Care Facility Lanagara
  14. 14. 21
  15. 15. Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes Diagnostic test utilization Data collection + analysis Collaboration with prescribers Academic Detailing Education Stewardship Infrastructure Optimize Antimicrobial Use Formulary restrictions
  16. 16. Year to Date (YTD) Antibiotic Expenditures $1,600,000 $1,400,000 Actual Expenditures $1,200,000 $1,000,000 $800,000 $600,000 Budgeted Expenditures $400,000 $200,000 $0 1 2 3 4 5 6 7 8 Periods 9 10 11 12 13
  17. 17. Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes Diagnostic test utilization Data collection + analysis Collaboration with prescribers Academic Detailing Education Organizational Structure Optimize Antimicrobial Use Formulary restrictions
  18. 18. Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes Diagnostic test utilization Data collection + analysis Collaboration with prescribers Academic Detailing Education Stewardship Infrastructure Optimize Antimicrobial Use Formulary restrictions
  19. 19. Call to action • The next time you prescribe an antimicrobial or assess the need for an antimicrobial, ask yourself: – What am I treating? – How long should I treat? – Is there an alternative, more appropriate antibiotic? bugs&drugs@providencehealth.bc.ca

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