provision of antimicrobial stewardship support to coastal, rural, and remote hospitals
TRANSCRIPT
ANTIMICROBIAL STEWARDSHIP
Provision of Antimicrobial Stewardship Support to Coastal
Rural and Remote Hospitals
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Tim T.Y. Lau, PharmD, FCSHP
Pharmacy Lead, ASPIRES, VCH
Clinical Supervisor & Infectious Diseases/Antimicrobial Stewardship
Pharmacist, VGH
Daljit Ghag, PharmD,
Antimicrobial Stewardship Pharmacist, ASPIRES, VCH, VGH
Clinical Instructor, Faculty of Pharmaceutical
Sciences, UBC
On behalf of the ASPIRES Team: Dr. Jennifer Grant, Salomeh Shajari, Felicia Laing
AntimicrobialStewardshipProgrammeInnovationResearchEducationSafety
Martin Emig, BSc(Pharm)
Pharmacy Coordinator, PRGH
ASPIRES, VCH
Conflicts of Interest
• None to declare
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Questions?
1. What is antimicrobial stewardship?
2. Why do we need stewardship support at Coastal rural/remote sites?
3. How are we collaborating with rural/remote sites?
4. How are we doing at rural/remote sites?
5. What clinical resources are available for stewardship?
6. What are challenges with providing support for rural/remote sites?
7. What are lessons learnt?
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1. What is antimicrobial
stewardship?
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Aim Drivers Initiatives
• Improve patient outcomes
• Optimize antibiotic therapy
• Reduce selection for antibiotic resistance
• Reduce antibiotic adverse events
Academic
Detailing and
Interventions
Education and
Clinical Tools
Systems
Improvement
Evaluation and
Measurement
• New Rapid Diagnostic Technologies through Medical Microbiology
• Sunset Patient Screening Reports
• Sunset CDI Electronic reporting and intervention databases
• Audit and Feedback
o Broad-Spectrum
o IV to PO
o Antifungals
• Anti-Infective Comparison Card
• Clinical Practice Guidelines: CAP, CDI, Surgical Prophylaxis, UTI, VAP
• Common Infections Card
• PPOs: CAP, Sepsis, SSTI, UTI
• Prescriber Engagement
• Restricted Antibiotics PPO
• Antibiotic Utilization
• Anti-Infective Costs
• CDI Pharmacy Follow-Up
• Databases for Audit and Feedback Interventions
• Interventions and Compliance
Antimicrobial Stewardship
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2. Why do we need
stewardship support at Coastal
rural and remote sites?
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2. Why do we need stewardship support
at Coastal rural and remote sites?
• Antimicrobial stewardship
– Accreditation Canada
• Required Organizational Practice
– Ministry of Health
• Clinical Care Management initiative
• Antimicrobial Stewardship Programme
(ASPIRES), Quality & Patient Safety at VCH
– Promote good antimicrobial prescribing
– Provide resource
– Improve patient outcomes and safety
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3. How are we collaborating
with rural/remote sites?
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3. How are we collaborating with
rural/remote sites?
• January 2015
– Martin Emig recruited as ASPIRES liaison
– Identified key physician, pharmacy, nursing, and
infection control stakeholders
• February 2015
– Site visits to establish local working groups; Bella
Coola already had stewardship group in place
– Environmental scan for stewardship activities
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3. How are we collaborating with
rural/remote sites?
• March 2015
– Established baseline antibiotic consumption data at
sites to track usage over time
• April 2015
– Provided site-specific clinical guidelines/resource
support
• November 2015
– Videoconference educational sessions and updates
of stewardship initiatives at sites
– Planned quarterly sessions
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4. How are we doing at
rural/remote sites?
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Site Bella Bella Bella Coola
Powell River Sechelt Squamish
Medical Director
Dr. Lauri-Ann Shearer Dr. Erika Cheng
Dr. Pierre Duplessis
Dr. Sara Wadge Dr. Richard Cudmore
Physician Dr. Lauri-Ann Shearer Dr. Erika
Cheng
Dr. Blake
Hoffert
Dr. Sara Wadge
(Dr. Jesse Morantz)
Dr. Jim (James)
Jamieson
Pharmacist Mohamad Naser, (locums)
Donna Ratcliffe
Martin Emig Ann Beardsell Dr. Tony Howarth
Nurse Genvieve Latrace;
Susan Chatelier
Susan
Koury
Nova Cleghorn Monique Roy-
Michaeli
Veronica Fincham
4. How are we doing at rural/remote
sites?
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Carbapenems: Imipenem/Meropenem
IV with Oral Bio-equivalents (eligible for oral step-down): Clindamycin, Ciprofloxacin, Cotrimoxazole, Metronidazole,
Moxifloxacin (No Linezolid use at any of the 5 sites).=
Broad-Spectrum or Restricted: Vancomycin, Ceftazidime, Piperacillin-tazobactam (No Daptomycin use at any of the 5 sites)
SGH: TBD
Data based on purchasing records
4. How are we doing at rural/remote
sites? Target Antibiotics Utilization at Rural/Remote Sites
FY 2014/15
• Antimicrobial Stewardship Survey
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4. How are we doing at rural/remote
sites?
Bella Bella
• ASP needs:
1. Customize local
guidelines/pocket cards (SSTI
and MRSA)
2. Develop common infections
PPO
3. Provide ID/Med
Micro/Pharmacy contact
resource
Bella Coola
• ASP needs:
1. Customize local guidelines/
resources (antibiogram, UTI)
2. Develop criteria for
piperacillin-tazobactam audit
3. Provide educational sessions
(video and teleconferencing)
4. How are we doing at rural/remote
sites?
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Powell River
ASP needs:
1. Customize local guidelines/
pocket cards (UTI algorithm)
2. Develop criteria for
piperacillin-tazobactam use
3. Provide prescriber education
Sechelt
• ASP needs:
1. Develop criteria for
ertapenem use
2. Customize common
infections card for site
3. Provide education on IV to
PO stepdown criteria
4. How are we doing at rural/remote
sites?
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4. How are we doing at rural/remote
sites?
Squamish
• ASP needs:
1. Customize local
guidelines/pocket cards
(common infections)
2. Develop criteria for ertapenem
use
3. Provide ID/Med Micro contact
resource
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5. What clinical resources are available for stewardship?
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5. What clinical resources are available for stewardship?
VCH intranet site
5. What clinical resources are available for stewardship?
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6. What are challenges with providing support for
rural/remote sites?
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6. What are challenges with providing support for rural/remote sites?
1. Limited resources and manpower
• Regionally
• Locally
2. Communication gap
3. Identity
4. Data source
5. Maintenance of momentum
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7. What are lessons learnt?
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7. What are lessons learnt?
1. Collaborative effort
2. Identification and engagement of key
stakeholders
3. Respect cultural and practice differences
4. Customize resource support
5. Encourage ownership
“Improve patient care and safety…”
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Questions?
• Dr. Jennifer Grant Medical Director,
ASPIRES
Email: [email protected]
• Dr. Tim Lau
Pharmacy Lead, ASPIRES
Email: [email protected]
• Dr. Daljit Ghag Antimicrobial Stewardship Pharmacist,
ASPIRES
Email: [email protected]
• Martin Emig
Coastal Rural Pharmacy Liaison, ASPIRES
Email: [email protected]
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