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Initiating an Antimicrobial Stewardship Program at BC Children's Hospital Quality Forum 2015 Ashley Roberts, MD, M.Ed, FRCP(C) Karen Ng, BSc.Pharm, ACPR, PharmD, BCPS February 19, 2015 Disclosures • We have no conflicts of interest to declare Goals of Antimicrobial Stewardship “to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use” • Reduce risk of infections • Reduce adverse drug events related to antimicrobial use • Reduce or stabilize antibiotic resistance • Promote patient safety BC Children’s Hospital Antimicrobial Stewardship Program • 180-bed tertiary care academic hospital and major referral centre for acutely ill or injured children • Antimicrobial Stewardship Program implemented September 2013 Challenges of Implementing a Pediatric Antimicrobial Stewardship Program (ASP) • Limited evidence vs. adult programs for ASP implementation • Fragilities of neonatal and pediatric population • Limited evidence and treatment guidelines for pediatric infections Pharmacother 2012;32(8):735-743. Key #1 Collaboration • • “Collective Ownership” Promote Mutual Learning 1. Collaboration Antimicrobial Stewardship Team at BC Children’s and Women’s Hospital Form an effective multidisciplinary AMS team of core members. ASP Member Role Dr. Ashley Roberts PHSA AMS Director, Infectious Diseases Specialist Dr. Simon Dobson Co-chair, Infectious Diseases Specialist, Infection Preventionist Dr. Karen Ng Dr. Vanessa Paquette Clinical Pharmacy Specialists Dr. Peter Tilley Medical Microbiologist Dr. Srinivas Murthy Dr. Rod Rassekh Dr. Joseph Ting Pediatric Intensive Care Champion Oncology AMS Champion Neonatal Intensive Care Champion Dr. Roxane Carr Pharmacy Clinical Coordinator 1. Collaboration Antimicrobial Stewardship Team at BC Children’s and Women’s Hospital Form an effective multidisciplinary AMS team of core members. P ARTNERSHIP WITH MICROBIOLOGY IS ESSENTIAL ASP Member Role •Dr.Antibiogram Ashley Robertsproduction PHSA AMS Director, Infectious Diseases Specialist •Dr.Bacterial susceptibilityCo-chair, breakpoints tailoring and antimicrobial dose Simon Dobson Infectious Diseases Specialist, Infection Control optimization Dr. Karen Ng Clinical Pharmacy Specialists • Microbiology reports and comments modifications Dr. Vanessa Paquette • Implementation of new guidelines/initiatives Dr. Peter Tilley Medical Microbiologist Dr. Srinivas Murthy Dr. Rod Rassekh Dr. Joseph Ting Pediatric Intensive Care Champion Oncology AMS Champion Neonatal Intensive Care Champion Dr. Roxane Carr Pharmacy Clinical Coordinator 1. Collaboration Antimicrobial Stewardship Team at BC Children’s and Women’s Hospital Form an effective multidisciplinary AMS team of core members. IASP DENTIFY Member ASP CHAMPIONS Role Dr. Ashley Roberts AMS Director, Infectious Diseases Specialist Physicians with interest inPHSA infectious diseases Dr. Simon Dobson Co-chair, Infectious Diseases Specialist, Infection Control Promotes collaboration and acceptance of ASP interventions Expands opportunities for research Dr. Karen Ng Clinical Pharmacy Specialists Dr. Vanessa Paquette Dr. Peter Tilley Medical Microbiologist Dr. Srinivas Murthy Dr. Rod Rassekh Dr. Joseph Ting Pediatric Intensive Care Champion Oncology AMS Champion Neonatal Intensive Care Champion Dr. Roxane Carr Pharmacy Clinical Coordinator 1. Collaboration • Example: Partnership with NSQIP (National Surgical Quality Improvement Program) Key #2 Optimize Available Resources AMS Pharmacist 12 AMS Pharmacist 13 Key #2: Optimize Available Resources Teamwork-driven daily prospective audit and feedback • Microbiology liaison • Infection Control liaison • Infectious Diseases team • Partnership with clinical pharmacists Key #3 Adapt Strategies to Your Site • Understand local culture and attitudes • Evaluate “worst offenders” • Establish achievable goals Key #3: Adapt Strategies to Your Site At BC Children’s Hospital: Strategies Used/Adopted Strategies Bypassed Daily prospective audit and feedback Formulary restrictions Dose optimization Automatic stop orders Education, development of guidelines and order sets Preauthorization requirements Active surveillance Ongoing research Key #3: Adapt Strategies to Your Site •Most ASPs target specific antimicrobials in audit and feedback. •BC Children’s Hospital experience: Audit all antimicrobials Cumulative # Interventions in 2014 0 cefotaxime/ceftriaxone vancomycin 1st-gen cephalosporins amoxicillin/ampicillin aminoglycosides piperacillin/tazobactam metronidazole cloxacillin clindamycin meropenem acyclovir fluconazole ciprofloxacin macrolides amox/clav voriconazole 2nd-gen cephalosporins sulfamethoxazole-trimethoprim Other 100 200 300 400 500 Adapting Antimicrobial Stewardship to the Pediatric Population… Reflections and Lessons Learnt • Limited evidence requires greater flexibility, discussion and collaboration • Continual reassessment and readjustment of ASP strategies and initiatives • Must not forget the humanistic factor • Data collection and analyses are crucial “from restriction to facilitation” Am J Health Syst Pharm 2011;68:109-10 Summary: Keys to Success Initiating an ASP in a Pediatric Hospital 1. Collaboration 2. Optimize available resources 3. Adapt strategies to local culture and attitudes Questions? Ashley Roberts [email protected] Karen Ng [email protected] 604-875-2000 ext 5952 Pager: BCCH Antimicrobial Stewardship