Antimicrobial Stewardship A Ministry Approach J Gavin Cotter

Antimicrobial Stewardship: A Ministry Approach J Gavin Cotter MD MPH Director Antimicrobial Stewardship UICOMP Assistant Professor of Clinical Medicine Infectious Disease

OSF Healthcare • Owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Illinois. • 11 acute care facilities • 1 Hospice House • OSF Prompt Care • 2 Colleges of Nursing • OSF Medical Group

OSF Healthcare: Hospitals • • • Saint James-John W Albrecht Medical Center – Pontiac, IL – Beds: 42 Saint Joseph Medical Center – Bloomington, IL – Beds: 149 Saint Luke Medical Center – Kewanee, IL – Beds: 25 Saint Francis Medical Center – Peoria, IL – Beds: 609 Holy Family Medical Center – Monmouth, IL – Beds: 23 Saint Anthony’s Health Center – Alton, IL – Beds: 203 • • • Saint Mary Medical Center – Galesburg, IL – Beds: 90 Saint Elizabeth Medical Center – Ottawa, IL – Beds: 97 Saint Anthony Medical Center – Rockford, IL – Beds: 254 St. Francis Hospital and Medical Group – Escanaba, MI – Beds: 25 Saint Paul Medical Center – Mendota, IL – Beds: 25

OSF ASP Aims • To create a formalized Inpatient ASP at OSF SFMC. • To support pre – existing inpatient efforts within OSF Healthcare and transition these efforts into formalized Inpatient ASPs. • To create new inpatient ASPs within OSF Healthcare. • To develop an Ambulatory ASP within OSF Healthcare.

Steps • Process Redesign • Formed a Powerful Coalition • Created a simple vision:

OSF SFMC ASP Action Items • Order sets – PNA – CAP/HCAP – Sepsis • • • Thera. Doc® EZ-Alerts SCIP Drug Reviews Education Branding – “The antibiotics people. ”

OSF ASP Aims • To create a formalized Inpatient ASP at OSF SFMC. • To support pre – existing inpatient efforts within OSF Healthcare and transition these efforts into formalized Inpatient ASPs. • To create new inpatient ASPs within OSF Healthcare. • To develop an Ambulatory ASP within OSF Healthcare.

OSF Healthcare: Vision • Embracing God's great gift of life, we are One OSF ministry transforming health care to improve the lives of those we serve.

SAMC and SJMC • Thera. Doc® EZ-Alerts • Established Pharm. D ID position at Rockford • Vanco/Aminoglycosides Protocols Centers of Innovation • IV to PO • CRRT dosing

SAMC Levofloxacin Utilization

OSF ASP Aims • To create a formalized Inpatient ASP at OSF SFMC. • To support pre – existing inpatient efforts within OSF Healthcare and transition these efforts into formalized Inpatient ASPs. • To create new inpatient ASPs within OSF Healthcare. • To develop an Ambulatory ASP within OSF Healthcare.

SMMC and SJMC- Pontiac • Consolidate Improvements and Produce Still More Change – Education Efforts- Visiting lectures – Speak directly to Local Administration – Pharmacists Trained in ASP – Identify Local Champions

IDPH Collaborative • Illinois Collaborative for Hospital Antimicrobial Stewardship Enhancement(ICHASE)

OSF Facilities Participating § Saint Joseph Medical Center § Zosyn® § Saint James-John W Albrecht Medical Center § Levaquin § Saint Mary Medical Center § Levaquin § Saint Francis Medical Center § Meropenem § Saint Anthony Medical Center § Levaquin and Zosyn®

Levofloxacin Criteria for Use

Piperacillin/Tazobactam (Zosyn®) Criteria for Use

Meropenem Criteria for Use

SAMC Piperacillin/Tazobactam Utilization

SMMC Levofloxacin Utilization

SJMC Levaquin Utilization

OSF ASP Aims • To create a formalized Inpatient ASP at OSF SFMC. • To support pre – existing inpatient efforts within OSF Healthcare and transition these efforts into formalized Inpatient ASPs. • To create new inpatient ASPs within OSF Healthcare. More to do! • To develop an Ambulatory ASP within OSF Healthcare.

OSF Medical Group: A revisited opportunity. • 1 st attempt 2011 – Failure • Plea for help – 2014 – Clostridium Difficile • A major problem in both inpatient and outpatient settings throughout the ministry. • At SFMC 85% of cases originate as outpatient. • Order set revised 2012, then again 2014. • Multiple Service lines concerned. • Administrative support

New Outpatient ASP • C diff collaborative created • Outpatient: – Identify most commonly used antimicrobials – Identify most common infectious diagnoses • Education curriculum developed • Outpatient Infusion Center – Algorithm – Request reviews

Greatest Lessons Learned • • • Attitudes, Knowledge, Beliefs Communication Branding Data IT is not a barrier Outpatient ASP is a very different culture than Inpatient ASP