Antimicrobial Stewardship A Team Approach at MRMC Kimberly

Antimicrobial Stewardship A Team Approach at MRMC Kimberly E. Knox, RN, MHA, CIC

Focus of Presentation Describing the efforts that one medical center made in establishing an antimicrobial stewardship program.

The Multidisciplinary Team Sue Otocki, Director of Pharmacy Paula Flynn, Staff Pharmacist Jen Schelin, Staff Pharmacist Pharmacy students Maureen Harris, Microbiology Supervisor Michael Newstein, MD, Ph. D, Infectious Disease Specialist Erin Grenier, IP Kim Knox, IP

The Team Implemented: Front end restriction Back end restriction Retrospective review of drug orders Formulary restrictions Automatic stop orders

The Team Implemented: ID consult required Verbal approval IV to PO switch Monthly review of the following antimicrobials per 1000 patient days at P&T and IP&C Committees: Cipro Invanz Levaquin Zosyn

Infectious Disease Specialist Attends Department of Medicine and Surgery meetings to share information about: Antimicrobial stewardship Proton pump inhibitor use Posts on the MRMC Intranet: Common Infectious Diseases and Empiric Antibiotic Recommendations for Adult ER and Inpatients Antibiogram

Proton Pump Inhibitor (PPI) Reduction Recent FDA black box warning indicates that the use of PPI can increase an individual’s risk of acquiring CDI What we are doing: Recommendations for discontinuing therapy before or at the time of discharge Working with partnering SNFs to foster appropriate PPI use for their residents Recent review shows a reduction in patients being discharged from MRMC on PPIs Information was highlighted in the April 2012 Pharmacy Newsletter

C DIFF Reduction Partnership Collaborative Information is shared with our community SNF by partners at monthly meetings including: Appropriate use of medication Cleaning techniques New technology or products Education for EOC staff

SCIP MRMC follows recommendations for SCIP antimicrobial prophylaxis for surgical procedures IS, Nursing Informatics, Surgeons, Infectious Disease and IP&C worked together in developing CPOE to be compatible with our goals

Amerinet Healthcare Achievement Award May 2012 MRMC Antibiotic Stewardship pharmacists won Amerinet Healthcare Achievement Award for Financial and Operational Improvement

Amerinet Healthcare Achievement Award The program that was implemented to decrease Zosyn usage In one year, the program decreased our costs and usage approximately sixty percent!

Cipro Doses per 1000 Patient Days 100 Cipro Doses per 1000 Patient Days 90 80 70 60 50 Cipro Doses per 1000 Patient Days 40 30 20 10 0 сен-11 окт-11 ноя-11 дек-11 янв-12 фев-12 мар-12 апр-12 май-12

май-12 апр-12 мар-12 мар-12 20 фев-12 янв-12 дек-11 дек-11 ноя-11 50 окт-11 окт-11 сен-11 Invanz Doses per 1000 Patient Days 45 40 35 30 25 Invanz Doses per 1000 Patient Days 15 10 5 0

Levaquin Doses per 1000 Patient Days 120 Levaquin Doses per 1000 Patient Days 100 80 Levaquin Doses per 1000 Patient Days 60 Linear(Levaquin Doses per 1000 Patient Days) 40 20 0 MMM-yy MMM-yy

Zosyn Doses per 300 1000 Patient Days Zosyn Doses per 1000 Patient Days 250 200 Zosyn Doses per 1000 Patient Days 150 Linear(Zosyn Doses per Patient Days) 1000 100 50 0 MMM-yy MMM-yy MMM-yy

Objectives To highlight the importance of: • Implementing a multidisciplinary team in establishing an antimicrobial stewardship program • Developing multipronged communication efforts for distributing information

Thank you!