initiating and sustaining an effective ......initiating and sustaining an effective antimicrobial...
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Tasha St. John
PharmD
INITIATING AND
SUSTAINING AN EFFECTIVE
ANTIMICROBIAL
STEWARDSHIP PROGRAM
IN THE OUTPATIENT
PRACTICES OF A HEALTH
SYSTEM
1. Commitment▪ Write and display public commitments in support of antibiotic stewardship
▪ Identify a single leader to direct antibiotic stewardship activities
2. Action▪ Use evidence based diagnostic criteria and treatment recommendations
▪ Use delayed prescribing practices or watchful waiting when appropriate
▪ Provide support for clinical decisions
3. Tracking and Reporting▪ Track and report antibiotic prescribing for one or more high priority
conditions
4. Education and Expertise▪ Provide patient education materials
▪ Provide face to face educational training for providers (academic detailing)
CHECKLIST FOR CORE ELEMENTS OF
OUTPATIENT ANTIBIOTIC STEWARDSHIP
▪ Ellis Medicine consists of Ellis Hospital, Bellevue
Women’s Center, McClellan Street Health Center, 9
primary care practices and 3 urgent care centers
▪ Providers include- MD, NP, PA
▪ Antibiogram available for outpatient urinary isolates
and combined isolates
▪ Partnered with IPRO to participate in their
Outpatient Stewardship Project
ELLIS MEDICINE
▪ Antibiotic use patterns for all primary care
practices- System Level.
▪ Antibiotic use patterns for all primary care
practices- Practice Level
▪ Antibiotic use patterns by individual NPI- Academic
Detailing
▪ Length of therapy report by individual antibiotic.
ELLIS MEDICINE MEDICARE DATA
REPORTS
ELLIS MEDICINE MEDICARE
PRESCRIBING PATTERNS- PRIMARY CARE
ELLIS MEDICINE – ACUTE
BRONCHITIS REPORT 2017
▪ Primary care clinic site visits in October 2017, April
2018 and October 2018
▪ Distributed antimicrobial stewardship educational
materials focusing on appropriate antibiotic use
▪ Materials created internally through Ellis Medicine’s
Antimicrobial Stewardship Committee as well as provided by
IPRO Stewardship Collaborative
▪ Provided site specific prescribing data to each
location and discussed areas for improvement
▪ Emphasized decreasing fluoroquinolone and azithromycin
prescribing
EDUCATION INTERVENTION
RESOURCE- NYS DOH ADULT AND
PEDIATRIC TREATMENT GUIDELINES
8
RESOURCE- IPRO JAMA CELLULITIS
POCKET GUIDE
RESOURCE – ELLIS MEDICINE
PENICILLIN ALLERGY ALGORITHM
▪ Difficult to discuss prescribing habits –
practitioners are aware of antibiotic overuse but
feel it is “someone else, not me”
▪ Frequent communication will be the key to success
▪ Practice sites are unaware of the role antimicrobial
stewardship plays in outpatient setting
▪ New proposed Joint Commission Standards for outpatient
antimicrobial stewardship
LESSONS LEARNED
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