Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Tyler Continue Care Hospital Antibiotic Stewardship Program Presentation Dr. Richard Yates Program Director * Director of Pharmacy James Ross CEO Stephanie Hyde MSN * CNO PeytonWindham PROGRAM DESCRIPTION EFFECTIVENESS OF AN ANTIBIOTIC STEWARDSHIP COMMITTEE (ASC) ON ANTIMICROBIAL COSTS AND RESISTANCE IN A LONG TERM ACUTE CARE HOSPITAL (LTAC). Antibiotic stewardship programs have been shown to be effective in reducing antibiotic utilization, costs and in reducing resistance rates in acute care hospitals. This process includes developing a team of clinical pharmacists, infection control personnel, and infectious disease physicians who review antibiotic use in the hospital setting, and recommended changes to prescribing physicians on a same-day basis. Richard R.Yates MD , James T. Ross RPh, Kristi Williams PharmD; Tyler Continue Care Hospital, Tyler, Texas. Introduction: ASCs have been used in acute care hospitals to review antimicrobial use to decrease inappropriate choice, dose and duration of antibiotic orders. We began an ASC at a 51 bed LTAC hospital and measured the impact on antimicrobial use and development of resistant organisms. Methods: Meetings between an Infectious Disease (ID) physician and clinical pharmacists were held two times a week to review all antibiotic orders on inpatients. Candidates for intervention were identified, and recommendations were made by the pharmacist to the ordering physician. Interventions were made within 24 hours, primarily through direct verbal communication. All recommendations were voluntary. The ID physician would intervene if questions, disputes, or patient safety issues occurred. Monthly antimicrobial use, C. difficile, VRE, ESBL, and MRSA rates were followed for the calendar year 2007. Interventions began in April 2007. Results: Total monthly antimicrobial expenditures decreased from an average of $64,000 the three months before the ASC to $30,124 average for 2011. Antimicrobial cost per patient day fell from $45 to $23 average for 2011. Antimicrobial costs as a percentage of total medication cost fell from 37.5% to 25%. Linezolid cost fell from $7400 to $3600. Daptomycin utilization has been reduced from was $7879 to $4723 but still represents a significant portion of expenditure. Echinocandin decreased during the same period, and quinolone costs were lower. Hospital associated resistant organisms as well as C. difficile, VRE, and ESBL were followed during the same period. Conclusions: Development of an ASC proved effective in decreasing antimicrobial expenditures in a 51 bed LTAC between April 2007and Oct of 2011. Improvement in development of some hospital associated infections also occurred. No significant adverse events were identified. Clinical Implications: Decreasing antibiotic use has been shown to improve antimicrobial resistance in multiple settings. Development of an ASC improves the likelihood antibiotics will not be misused or overused. This results in easily measured cost savings to the institutions. More importantly, but more difficult to measure, is the health benefit to patients in preventing adverse events and decreasing the rate of drug resistant organisms in the hospital. Given the longer stays, prolonged antibiotic exposure, and potentially higher bacterial and fungal resistance pressures an antibiotic stewardship committee was established in 2007 at a 51-bed Long Term Acute Care Hospital (LTACH). Anti-infective expenditures as well as the impact on antimicrobial resistance and hospital acquired infections were measured. Our goal was to reduce the overall antimicrobial use, encourage use of antibiotics which induce little resistance, and shorten the overall antibiotic exposure to patients. The program was set up between a clinical pharmacist and Infectious Disease (ID) physician meeting twice weekly. Patients receiving antibiotics were evaluated and reviewed for drug selection/appropriateness, dose, duration, renal function, and microbiology lab data. The pharmacist and ID physician would then discuss patients that required intervention. The pharmacist would then discuss possible changes with the prescribing physician. All interventions were recommendations only, none were mandatory. The committee would follow up the recommendations, offer educational supplements to the physicians, and keep meetings open to physicians for discussion. The committee would met periodically with the Infection Control Committee to monitor prescribing trends and their effect on antibiotic resistance within the hospital. Physicians were invited to join the committee any time with questions or concerns. EFFECTIVENESS OF AN ANTIBIOTIC STEWARDSHIP COMMITTEE (ASC) ON A HOSPITAL (LTAC). Richard R.Yates MD , James T. Ross RPh, Kristi Williams PharmD; Tyler Continue Care Hospital, Tyler, Texas. Introduction: ASCs have been used in acute care hospitals to review antimicrobial use to decrease inappropriate choice, dose and duration of antibiotic orders. We began an ASC at a 51 bed LTAC hospital and measured the impact on antimicrobial use and development of resistant organisms. Methods: Meetings between an Infectious Disease (ID) physician and clinical pharmacists were held two times a week to review all antibiotic orders on inpatients. Candidates for intervention were identified, and recommendations were made by the pharmacist to the ordering physician. Interventions were made within 24 hours, primarily through direct verbal communication. All recommendations were voluntary. The ID physician would intervene if questions, disputes, or patient safety issues occurred. Monthly antimicrobial use, C. difficile, VRE, ESBL, and MRSA rates were followed for the calendar year 2007. Interventions began in April 2007. Results: Total monthly antimicrobial expenditures decreased from an average of $64,000 the three months before the ASC to $30,124 average for 2011. Antimicrobial cost per patient day fell from $45 to $23 average for 2011. Antimicrobial costs as a percentage of total medication cost fell from 37.5% to 25%. Linezolid cost fell from $7400 to $3600. Daptomycin utilization has been reduced from was $7879 to $4723 but still represents a significant portion of expenditure. Echinocandin decreased during the same period, and quinolone costs were lower. Nosocomial acquired resistant organisms as well as C. difficile, VRE, and ESBL were followed during the same period. Conclusions: Development of an ASC proved effective in decreasing antimicrobial expenditures in a 51 bed LTAC between April 2007and Oct of 2011. Improvement in development of some nosocomial infections also occurred. No significant adverse events were identified. Clinical Implications: Decreasing antibiotic use has been shown to improve antimicrobial resistance in multiple settings. Development of an ASC improves the likelihood antibiotics will not be misused or overused. This results in easily measured cost savings to the institutions. More importantly, but more difficult to measure, is the health benefit to patients in preventing adverse events and decreasing the rate of drug resistant organisms in the hospital. RESULTS Our antibiotic stewardship program was organized and instituted in April 2007 following antibiotic expenditures and the impact on hospital acquired infections. On a monthly basis we tracked total antibiotic costs, antibiotic costs per patient day, and the impact of high cost antibiotic therapy. In addition we tracked hospital acquired infections with clostridium difficile colitis, vancomycin resistant entercocci (VRE), methicillin resistant staph aureus (MRSA), and extended spectrum beta-lactamase (ESBL) producing gram negative bacilli. With an average length of stay of 28 days and approximately 20% of patients receiving long term antibiotic therapy we were able to conclude that active antibiotic stewardship can reduce costs and more importantly decrease resistance and hospital associated infections. Resistance Impact Anti-Infective Cost/Patient Day $38.67 $25.49 $24.89 $24.07 $23.11 12 The antibiotic stewardship committee in conjunction with infection control was following cases of hospital acquired Clostridium difficile, VRE, MRSA, and ESBL producing organisms. We have seen a reduction in the number of cases of c. diff., VRE and MRSA which corresponds with a decrease in antibiotic costs and implementation of the Antibiotic Stewardship. Cases of ESBL producing organisms have not appreciably changed it well below the 9% United States national average. 20 11 Hospital Acquired Infections Total Number of Cases FY TD 20 10 20 09 20 20 20 08 $19.47 07 $45.00 $40.00 $35.00 $30.00 $25.00 $20.00 $15.00 $10.00 $5.00 $0.00 Anti-Infective Cost/Patient Day 35 30 25 Daptomycin Effect on Anti-Infective Cost $38.67 Anti-Infective Cost/Patient Day 20 Daptomycin Cost/PPD 15 C Diff VRE $40.00 $35.00 $30.00 $25.49 $24.89 $25.00 $24.07 MRSA $23.11 $19.47 ESBL 10 $20.00 $15.00 5 $10.00 $3.24 $5.00 $0.94 $0.33 $2.16 $3.24 $2.14 0 2 20 11 20 1 FY TD 20 10 20 09 20 08 20 07 $0.00 2007 2008 2009 2010 2011