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