Download 2014 ID Week ASP Poster

Implementing an Antimicrobial Stewardship Program
Angela Vassallo, MPH, MS, CIC, Snezana Naumovski, PharmD, Sarah Turkel, MPH, MS, MT(ASCP)
Tanya Elgourt, PharmD, Robert Winters, MD, and Ellie JC Goldstein, MD
Saint John’s Health Center, Santa Monica, CA
BACKGROUND
The Antimicrobial Stewardship
Program (ASP) at Providence
Saint John’s Health Center was
implemented in June, 2013. The
Antimicrobial Stewardship
Team, made up of
representatives from Pharmacy
and Infectious Disease
Services, was established in
two phases: 1st phase (3-6
months) and 2nd phase (>6
months).
1st phase:
1. Familiarize physicians with
the program
2. Develop physician
Interactions related to
antimicrobial stewardship
ASP Cost Saving Interventions: Drug Utilization
6/2013-06/2014
METHODS
The ASP tracked the following
interventions in each phase: IV to PO,
dosing adjustment redundancy, deescalation of restricted and high cost
antibiotics (Daptomycin, Ertapenem,
Ceftaroline, Linezolid, Vancomycin,
Cefepime and Piperacillin-tazobactam),
drug/bug mismatch, streamlining of broad
spectrum therapy and duration of
treatment.
The cost savings impact of the ASP was
determined by evaluating pharmacypurchasing data as well as the difference
in drug utilization, hospital-wide, during
the study period.
$100,000.00
$94,250.00
$90,000.00
$80,000.00
$70,000.00
$60,000.00
$50,000.00
$40,000.00
$30,000.00
$19,422.00
$20,000.00
$5,043.10
$10,000.00
$3,290.32
$10,140.00
$2,178.00
$-
RESULTS
3. Create policies and
procedures.
2nd
Phase: Identify and quantify
the benefits of the ASP (drug
cost savings, decreased length
of stay, decreased days of
therapy).
PURPOSE
The purpose of this study is to
evaluate the impact of
antimicrobial stewardship on
the usage of restricted and
broad spectrum antibiotics,
measured as the number of
doses administered over a
period of time. Additionally, the
stud determined the cost-saving
benefits of this program.
4500
Total Vancomycin Doses
01/01/2012-09/01/2014
Total Ertapenem Doses
01/01/2012-09/01/2014
14000
4030
4000
12000
3500
10000
3147
3000
2000
1836
1500
6000
5654
4000
1000
$500,000.00
8177
8000
2500
500
2000
0
0
Yr 2012
Antibiotic Expenditure July-December Yr2012 &Yr 2013:
Pharmacy-purchasing data
11695
Yr 2013
Yr 2014
Yr 2012
Yr 2013
Yr 2014
$498,786.68
Total Daptomycin Doses
01/01/2012-09/01/2014
$490,000.00
350
$480,000.00
600
366
500
300
$470,000.00
$462,640.73
$460,000.00
$450,000.00
250
200
300
150
200
80
50
Yr 2012
Yr 2013
501
400
236
100
$440,000.00
REFERENCES
Total Linezolid Doses
01/01/2012-09/01/2014
400
366
272
100
0
0
Yr 2012
Yr 2013
Yr 2014
Yr 2012
Yr 2013
CONCLUSION
Overall, physicians were
receptive to the ASP program
and intervention acceptance
increased with each phase of
implementation. Specifically,
ID physician intervention
acceptance increased from
19% in quarter 3, 2013 to 43%
in quarter 2, 2014. During
phases 1 and 2, the most
frequently made interventions
were redundancy and deescalation. De-escalation was
the highest cost saving
intervention ($94,250). Total
cost savings since ASP was
implemented was estimated
$134,323.42. Number of total
doses of restricted and high
cost antibiotics showed
significant decreases since
the start of ASP. Future ASP
goals are the development of
an ASP policy with
consequences for MDs who do
not follow ASP
recommendations and the
analysis of the possible
correlation between hospitalassociated MDROs and an
effective hospital ASP.
Yr 2014
APIC, Text for Infection Prevention, 2012
Dellit, TH et al. “Infectious Diseases Society of America and the
Society of Healthcare Epidemiology of America Guidelines for
Developing an Institutional Program to Enhance Antimicrobial
Stewardship”. Clin Infect Dis 2007:44
Goff, DA, et al. “Is the ‘Low-Hanging Fruit’ Worth Picking for
Antimicrobial Stewardship Programs?”. Clin Infect Dis
2012;55(4):587-92.
Goldstein, EJC, Trivedi, KK. “Antimicrobial Stewardship: The View
from California”. Infect Dis Clin Pract 2012;20:294-296.
Kullar R., Goff D.A., Schulz LT., et al. The ‘Epic’ Challenge of
Optimizing Antimicrobial Stewardship: The Role of Electronic
Medical Records and Technology. Clin Infect Dis 2013
Oct;57(7):1005-13.
Trivedi, KK, Rosenberg, The State of Antimicrobial Stewardship
Programs in California. J. Infect Control Hosp Epidemiol
2013;34(4):379-384.