jigsaw 101: medication initiative in action antimicrobial stewardship

We have an opportunity to delay the post-antibiotic era by improving physicians’ antibiotic prescribing behavior

Optimize Antimicrobial

Use Education

Academic Detailing

Diagnostic test utilization

Data collection + analysis

Stewardship Infrastructure

Collaboration with

prescribers

Formulary restrictions

Systematic and coordinated approach to selecting antimicrobials to achieve optimal outcomes

Inappropriate Antimicrobial Use

Indiscriminate laboratory testing

Knowledge gaps

Inadequate documentation and transitions in care

Diagnostic Uncertainty or Fear

PRIMARY DRIVERS OF INAPPROPRIATE ANTIMICROBIAL USE

Fallacies in Antimicrobial Therapy

- Broader is better

- Failure to respond is failure to cover

- When in doubt, change drugs or add

- More diseases, more drugs

- Sickness requires immediate treatment

- Response implies diagnosis

- Antibiotics are non-toxic

Spiraling empircism, Kim and Gallis, American Journal of Medicine, August 1989, Volume 87

Appropriateness of antimicrobials

CONSEQUENCES OF INAPPROPRIATE ANTIBIOTIC USE


Use Education

Academic Detailing


Data collection +

analysis Stewardship Infrastructure

Collaboration with

prescribers


Systematic and coordinated approach to using appropriate antimicrobial agents to achieve optimal outcomes

You are invited to a presentation entitled;

Antimicrobial Stewardship for Cardiac Surgery and Cardiology

Speakers: Dr. Peter Phillips & Dr. Victor Leung

Objectives: 1) Provide a brief overview of Antimicrobial Stewardship at PHC 2) Review of the 2012/2013 pilot of surgical site infection (SSI) surveillance post-CABG and valve surgery 3) Present revisions to peri-operative antimicrobials for cardiac procedures 4) Discuss the management of infections from cardiac arrhythmia device implants at PHC

Date and Time: Tuesday November 26, 2013 at 6:30 pm Location: Lupo Restaurant and Vinoteca (869 Hamilton St, Vancouver, BC V6B 2R7 2R7)

RSVP: [email protected]

Meal sponsored by

Educational Journal Club Events Reached over 100 Prescribers


Use Education

Academic Detailing


Data collection +


Collaboration with

prescribers


Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes

Academic detailing offers point-of-care education

• Microbiologic data

• Local resistance patterns

• Evidence based guidelines

• Potential errors:

• Broad spectrum

• Dosing

• medication interactions

• allergies


Use Education

Academic Detailing


Data collection +


Collaboration with

prescribers



Investing in ASP saves money

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

1 2 3 4 5 6 7 8 9 10 11 12 13

Periods

Year to Date (YTD) Antibiotic Expenditures

Actual Expenditures

Budgeted Expenditures

Antibiotic savings = $411,258 as of fiscal period 9


Use Education

Academic Detailing


Data collection +

analysis Organizational Structure

Collaboration with

prescribers




Use Education

Academic Detailing


Data collection +


Collaboration with

prescribers



Call to action

• The next time you prescribe an antimicrobial or assess the need for an antimicrobial, ask yourself:

– What am I treating?

– How long should I treat?

– Is there an alternative, more appropriate antibiotic?

bugs&[email protected]

mailto:bugs&[email protected]

jigsaw 101: medication initiative in action antimicrobial stewardship

Health & Medicine