How technology can bolster antimicrobial stewardship programs


Healthcare's capabilities are where they are today in large part due to antibiotics. Before antibiotics were routinely used, simple wounds could play host to deadly infections. Antibiotics have improved sepsis and chemotherapy associated infection survival rates, along with the feasibility to perform complex surgeries, just to name a few benefits.

However, the overuse of antibiotics poses a significant public health and safety threat, as bacteria adapt and develop resistance to such drugs.

To slow the development of resistance to such drugs and minimize the occurrence of related adverse events, hospitals are implementing antimicrobial stewardship programs to optimize antibiotic prescribing practices.

In a webinar hosted by Becker's Hospital Review and VigiLanz, a provider of clinical decision support surveillance software, panelists discussed how technology and clinical decision support systems can bolster antimicrobial stewardship programs.

Antimicrobial stewardship programs should be considered critical patient safety initiatives whose impact extends beyond the clinical outcomes, though many hospitals still do not have such stewardship programs in place, said Stacy Pur, RN, vice president of clinical decision support at VigiLanz. "Loss of antibiotic efficacy means loss of options around care," she said.

The lack of antimicrobial stewardship programs in hospitals may be slow to adopt programs because they don't have the tools to identify stewardship opportunities, making the task of implementing such a program daunting, Ms. Pur said. However, there are technology platforms to assist hospitals in developing effective programs.

What's more, in the infection control realm, manual tracking and reporting requirements can be time-consuming for those responsible. While Ms. Pur said mandated reporting is a good idea for identifying robust benchmark opportunities and garnering support for initiatives, manual reporting is not efficient. "As requirements around public health reporting have increased, individuals charged with leading infection prevention have faced increasing burdens around mandating report, leaving them significantly less time for what is the primary focus of their role: the prevention of infections," Ms. Pur says.

And this is where technology can come in and support hospital antimicrobial initiatives.

John Russillo, RPh, clinical pharmacy manager at Concord, Calif.-based John Muir Health, said staff education is a key element of antimicrobial stewardship programs that surveillance and CDS technologies can offer to providers.  

"Education of medical staff and practitioners is a big part of an antimicrobial stewardship program," Mr. Russillo said. "You can intervene every time, but over time you want to change the practice. You don't want to keep intervening every time."

John Muir Health has implemented VigiLanz's surveillance and reporting platforms, utilizing services such as automated dosing with clinical surveillance and drug interaction alerts. Mr. Russillo said having this automated technology helps achieve the efficiency and timeliness goals of an antimicrobial stewardship program. "We ask how are we using our antibiotics?" he said. "These tools calculate all this for you. You can break down the use by location, physician, unit type and then they can trend it by month or patient days so you get very good usage patterns of antibiotics in your institution."

Joshua Courter, PharmD, antimicrobial stewardship clinical pharmacist at Cincinnati Children's Hospital Medical Center, agreed, saying this transparency from the surveillance system helped bolster staff education surrounding antibiotic resistance. Cincinnati Children's Hospital Medical Center also uses VigiLanz's offerings. "Some of the largest things we gained when we moved to having a clinical support system was transparency," Dr. Courter said. "This allowed us to discuss Clostridium difficile rates and track our antibiotic use, which helps us to educate our staff on the perils of over-antibiotic use."

Additionally, both Mr. Russillo and Dr. Courter agreed that while financial incentives aren't the focal point of an antimicrobial stewardship program — reducing inappropriate antibiotic use is — it is a beneficial side effect. John Muir Health saved approximately $60,000 in its bottom line, and Cincinnati Children's Hospital Medical Center saved approximately $500,000 in antimicrobial expenditures.

However, both clinical and financial outcomes can serve as indicators of success of antimicrobial stewardship programs.

"Drug cost savings is always the first one administrators want to hear about, meaning you can show a reduction in use of antibiotics," Mr. Russillo said. "Really it should not be pushed as a cost savings. It really is a patient safety, outcome type goal. You're affecting things like mortality, C. diff rates, VRE, LRE emergence and all these have cost savings opportunities associated with them…. You're going to show a combination of cost savings but also improvement in outcomes, possible reductions in lengths of stay, possible reductions in critical care stays and overall use of antibiotics as well."

Download the webinar presentation here.

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Note: View archived webinars by clicking here.

More articles on antimicrobial stewardship:

Antibiotic resistance: 4 areas of progress, 6 challenges
Unnecessary antibiotic use leads to more than $163M in spending waste
11M+ unnecessary antibiotics prescribed to children each year


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