Jigsaw 101: Medication Initiative in Action Antimicrobial Stewardship

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Presented at Optimizing Medications workshop in Vancouver by Victor Leung

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Jigsaw 101: Medication Initiative in Action Antimicrobial Stewardship

  1. 1. We have an opportunity to delay the post-antibiotic era by improving physicians’ antibiotic prescribing behavior
  2. 2. 6
  3. 3. Systematic and coordinated approach to selecting antimicrobials to achieve optimal outcomes Diagnostic test utilization Data collection + analysis Collaboration with prescribers Academic Detailing Education Stewardship Infrastructure Optimize Antimicrobial Use Formulary restrictions
  4. 4. PRIMARY DRIVERS OF INAPPROPRIATE ANTIMICROBIAL USE Indiscriminate laboratory testing Knowledge gaps Inappropriate Antimicrobial Use Inadequate documentation and transitions in care Diagnostic Uncertainty or Fear
  5. 5. Fallacies in Antimicrobial Therapy - Broader is better - Failure to respond is failure to cover - When in doubt, change drugs or add - More diseases, more drugs - Sickness requires immediate treatment - Response implies diagnosis - Antibiotics are non-toxic Spiraling empircism, Kim and Gallis, American Journal of Medicine, August 1989, Volume 87
  6. 6. CONSEQUENCES OF INAPPROPRIATE ANTIBIOTIC USE Appropriateness of antimicrobials
  7. 7. 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
  8. 8. Educational Journal Club Events Reached over 100 Prescribers You are invited to a presentation entitled; Antimicrobial Stewardship for Cardiac Surgery and Cardiology Speakers: Dr. Peter Phillips & Dr. Victor Leung Objectives: 1) Provide a brief overview of Antimicrobial Stewardship at PHC 2) Review of the 2012/2013 pilot of surgical site infection (SSI) surveillance post-CABG and valve surgery 3) Present revisions to peri-operative antimicrobials for cardiac procedures 4) Discuss the management of infections from cardiac arrhythmia device implants at PHC Date and Time: Tuesday November 26, 2013 at 6:30 pm Location: Lupo Restaurant and Vinoteca (869 Hamilton St, Vancouver, BC V6B 2R7 2R7) RSVP: vleung@providencehealth.bc.ca Meal sponsored by
  9. 9. 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
  10. 10. Academic detailing offers point-of-care education • Microbiologic data • Local resistance patterns • Evidence based guidelines • Potential errors: • Broad spectrum • Dosing • medication interactions • allergies
  11. 11. 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
  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. Investing in ASP saves money Year to Date (YTD) Antibiotic Expenditures $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 Antibiotic savings = $411,258 as of fiscal period 9 $400,000 $200,000 $0 1 2 3 4 5 6 7 Periods 8 9 10 11 12 13 Actual Expenditures Budgeted Expenditures
  14. 14. 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
  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. 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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