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Antimicrobial Stewardship Program

What is Antimicrobial Stewardship? Effective antimicrobial stewardship programs, also known as antimicrobial management programs, have a primary goal of improved patient care. Stewardship includes minimizing inappropriate antimicrobial use while optimizing selection, dosing, route, and duration of therapy in an effort to maximize clinical cure, prevent infections, and limit the emergence of resistance, adverse drug events, and hospital costs.

 

The Program A comprehensive evidence-based stewardship program was implemented at Baystate Health on January 1, 2011. The program is co-managed by an Infectious Diseases physician and an Infectious Diseases pharmacist in conjunction with the Infectious Diseases, Pharmacy, Microbiology, Epidemiology, Information Services, and Healthcare Quality departments. The program is charged with promotion of the optimal use of antimicrobial agents, reduction of the transmission of infections, and education to healthcare professionals, patients, and the public.

 

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  • Expansion of the list of antimicrobials which require approval from a member of the Infectious Diseases Department or the Antimicrobial Stewardship team. Pre-authorization of broad-spectrum antibiotics leads to a more prudent use of these agents in order to prevent future resistance.  An example of this includes the restriction of meropenem implemented on October 2011.  The restriction resulted in a decrease from 16.6 days of therapy (DOT) per 1000 patient days in September 2011 to 6.4 DOT per 1000 patient days in December 2011.

 

  • Implementation of established empiric antibiotic guidelines into the computer order entry system. The guidelines provide suggestions regarding the most appropriate antibiotic for the suspected site of infection based on likely pathogens and local resistance patterns.

 

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  • Implementation of a protocol to ensure appropriate and timely intravenous-to-oral medication conversion per pharmacy occurred in 2011. Patients may be considered candidates for switching from IV to oral therapy once the patient meets pre-defined criteria. Once a patient qualifies, the pharmacy will automatically convert the IV antibiotic to the correct oral option within 24 hours. The benefits of early intravenous-to-oral conversions include shorter length of hospitalization, decreased risk of bloodstream infection or phlebitis, as well as more cost-efficient use of pharmacy and nursing resources.  In 2012, the program expanded to include non-antimicrobial agents.

 

  • Implementation of a protocol to provide aminoglycoside dosing and monitoring per pharmacy. An established dosing guideline is utilized by physicians and clinical pharmacists upon order entry and verification of such medications. Pharmacokinetic monitoring services are provided daily by a clinical pharmacist.  Pharmacist-managed aminoglycoside programs are associated with significant improvement in healthcare and economic outcomes.

 

  • Updated vancomycin dosing and drug level monitoring.  The guideline update includes dosing recommendations set forth by the Infectious Diseases Society of America to include weight-based dosing and monitoring suggestions for safe and effective therapy.

 

  • The Antimicrobial Stewardship Program continues to develop:
    • Implementation of an Indication for Use Criteria Program for broad-spectrum agents
    • Establishing an Antimicrobial Surveillance Team to prospectively audit broad-spectrum antimicrobial use and offer support to providers in terms of stream-lining therapy, patient-specific dose adjustments, and appropriate treatment duration.

 

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  • Baystate Franklin Medical Center actively implements antimicrobial stewardship initiatives via shared formularies and a shared computer order entry system.
  • Pharmacists provide active surveillance of antimicrobials at interdisciplinary rounds for patients in the intensive care, telemetry and medical/surgical units.
  • Since 2005, Baystate Franklin Medical Center pharmacists have provided a pharmacokinetic dosing service for patients receiving vancomycin and aminoglycosides for approximately 2500 patient days of dosing/year.  This program has optimized drug response with minimal toxicity and has improved efficiency around antimicrobial delivery and laboratory coordination.

 

For more information on Quality at Baystate Health

For more information on Baystate Medical Center

For more information on Baystate Franklin Medical Center

For more information on Baystate Mary Lane Hospital

 

 

  • Baystate Mary Lane Hospital actively participates in antimicrobial stewardship initiatives via shared formularies and a shared computer order entry system.
  • Pharmacists provide active surveillance of antimicrobials for conversion of IV-to-oral therapy and pharmacokinetic dosing services for patients receiving aminoglycosides or vancomycin.

 

For more information on Quality at Baystate Health

For more information on Baystate Medical Center

For more information on Baystate Franklin Medical Center

For more information on Baystate Mary Lane Hospital