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There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential
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There Aren't Any New Ones - Why Antibiotic Stewardship is now Essential

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This presentation was delivered in session C5 of Quality Forum 2014 by: …

This presentation was delivered in session C5 of Quality Forum 2014 by:

Jim Hutchinson
Medical Microbiologist, Island Health
Clinical Lead, BCPSQC

Published in: Health & Medicine
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  • 1. The New World of Stewardship Jim Hutchinson Medical Director - Antimicrobial Stewardship Island Health Clinical Lead – Antimicrobial Stewardship BCPSQC
  • 2. Muir Glacier Alaska 1940 2004
  • 3. Penicillin Resistant S. aureus Chambers et al EID 2001
  • 4. Resistance to antibiotics rapidly rising
  • 5. No new antibiotics
  • 6. Infections are not diagnosed well
  • 7. Antibiotics are not prescribed well
  • 8. The Solution?
  • 9. Structure
  • 10. Thought
  • 11. Care
  • 12. Collaboration
  • 13. Data
  • 14. Required Organizational Practice: The organization has a program for antimicrobial stewardship to optimize antimicrobial use.
  • 15. Spurred BC Action
  • 16. BC Ministry of Health • New Clinical Care Management area • Established Provincial Antimicrobial Clinical Expert group
  • 17. PACE
  • 18. PACE • Co-Chaired by Richard Bachand and I with ministry support • Established in spring 2013 • Aggressive work plan
  • 19. PACE activities • • • • Best practice review completed Survey of stewardship capacity completed Business case RFP out Assuming responsibility for the Antibiotic / Probiotic portions of the Provincial Hospital Formulary
  • 20. PACE activities • • • • Best practice review completed Survey of stewardship capacity completed Business case RFP out Assuming responsibility for the Antibiotic / Probiotic portions of the Provincial Hospital Formulary
  • 21. Which targeted antimicrobial stewardship activities are done at this facility? Time-sensitive Automatic Stop Orders Formalized IV to PO Conversion Program Education Program Guidelines and Clinical Pathways Pre-Authorization Prospective Audit with Intervention and Feedback Other 0% 10% 20% 30% 40% 50% 60% 26 70% 80%
  • 22. Which targeted antimicrobial stewardship activities are done at this facility? Time-sensitive Automatic Stop Orders Formalized IV to PO Conversion Program Education Program Guidelines and Clinical Pathways Pre-Authorization Prospective Audit with Intervention and Feedback Other 0% 10% 20% 30% 40% 50% 60% 27 70% 80%
  • 23. Prospective Audit with Intervention and Feedback By Health Authority 5 Number of Facilities 4 3 2 1 0 FHA IHA NHA PHC PHSA VHCA VIHA
  • 24. Audit and Feedback
  • 25. Unsolicited Help
  • 26. Helping everyone use antibiotics well
  • 27. Clinical Pharmacy backbone • Clinical Pharmacists are the “Foot Soldiers” • We don’t have enough • We MUST build capacity
  • 28. Clinical Pharmacy backbone This is essential
  • 29. Centralized medical oversight • Infection specialists (ID and Medical microbiologists) provide direct and responsible collaborative help to clinical pharmacists. • This is not the usual model of physician interaction and oversight
  • 30. Multidisciplinary help the process • Clinical pharmacists find people with infections – By antibiotic prescription – By microbiologic Dx – By algorithm • Advise on their management in collaboration with Specialist physician • Follow-up
  • 31. Multidisciplinary help the process It’s not Rocket Science
  • 32. Multidisciplinary help the process But it is tricky!
  • 33. Multidisciplinary help the process • Trust must be established • Collegial, educational, non-punitive • Direct physician to physician interaction very important at the outset
  • 34. Progress in Island Health • Friends are being made • Foundations are being built
  • 35. Unsolicited Help Clinical pharmacists hired in: • • • • Nanaimo Campbell River Cowichan District Victoria
  • 36. Unsolicited Help • They have found hundreds of patients • They have phoned me (and my colleagues) many, many times • They have helped!
  • 37. And most importantly…
  • 38. Now they are local, trusted, collaborative colleagues
  • 39. PACE activities • • • • Best practice review completed Survey of stewardship capacity completed Business case RFP out Assuming responsibility for the Antibiotic / Probiotic portions of the Provincial Hospital Formulary
  • 40. Which of the following metrics are used to evaluate antimicrobial usage? 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Defined Daily Dose Days of Therapy Length of Therapy Total Cost of Antibiotics None 45 Other
  • 41. Not much measuring
  • 42. But every prescription is electronic… Hmmm…
  • 43. SEISMIC
  • 44. SEISMIC Surveillance and Epidemiology of Infections, Stewardship, Microbiology, and Infection Control A Quality Assurance & Surveillance Analytical Environment for Microbiology, Antibiotic Stewardship and Infection Control “a roadmap for the development of enhanced clinical analytical capacity within Island Health”
  • 45. “a roadmap for the development of enhanced clinical analytical capacity within Island Health”
  • 46. SEISMIC • Extension of the Business Intelligence Data Warehouse • Re-purposing transactional data to facilitate quality care
  • 47. What data is needed for quality management of infections? • Antibiotic use • Antibiotic resistance – “Antibiogram” • Measures of inflammation – e.g. WBC, Temperature, Procalcitonin • Outcome measures – e.g. LOS, mortality, complications, readmissions
  • 48. First blush • Antibiotic use • Based on orders – Much better to use administration data
  • 49. Future of SEISMIC • Relate antibiotic use to resistance • Relate antibiotic use to outcomes • Predict appropriate empiric therapy by personal microbiologic history • Etc., etc., etc.
  • 50. Future of SEISMIC Iterative analysis
  • 51. Forever
  • 52. The ultimate vision • All people on Vancouver Island will have their infections anticipated, prevented, diagnosed and treated in a thoughtful, efficient, SYSTEMATIC fashion.
  • 53. The ultimate vision • All people in British Columbia will have their infections anticipated, prevented, diagnosed and treated in a thoughtful, efficient, SYSTEMATIC fashion.
  • 54. We are building a permanent system
  • 55. Why just antibiotics?
  • 56. Stewardship of everything

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