AntimicrobialStewardshipProgrammeInnovationResearchEducationSa fety Development and Implementation of a “Reserved Antimicrobial Drugs” (RAD) Pre-Printed Order at the Vancouver General Hospital Tim T.Y. Lau, PharmD, FCSHP Pharmacy Lead, ASPIRES, Quality & Patient Safety, Vancouver Coastal Health Clinical Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia On behalf of the ASPIRES team Dr. Jennifer Grant, Dr. Titus Wong, Dr. Daljit Ghag, Felicia Laing, Salomeh Shajari February 2015 1
Development and Implementation of a“Reserved Antimicrobial Drugs”(RAD) Pre-Printed Order at the
Vancouver General Hospital
Tim T.Y. Lau, PharmD, FCSHPPharmacy Lead, ASPIRES, Quality & Patient Safety, Vancouver Coastal Health
Clinical Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia
On behalf of the ASPIRES teamDr. Jennifer Grant, Dr. Titus Wong, Dr. Daljit Ghag, Felicia Laing, Salomeh Shajari
February 2015
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Conflict of Interest
• None to declare
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Questions
1. What are Reserved Antimicrobial Drugs (RADs)?
2. How do we ensure RADs are prescribed appropriately?
3. What is the RAD pre-printed order (RAD PPO)?4. What are challenges when developing and
implementing a RAD PPO?5. How do we evaluate a RAD program?6. What are lessons learnt from the RAD
program?
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1. What are Reserved Antimicrobial Drugs (RADs)?
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Reserved Antimicrobial Drugs (RADs)
• Background– Since 2013, BC Health Authorities Pharmacy
& Therapeutics (BCHA P&T) Committee developed criteria for target RADs
– Rationale:• Promote appropriate antibiotic use;• Prevent emergence and spread of multi-drug
resistant organisms
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2. How do we ensure RADs are prescribed appropriately?
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RAD appropriateness
• No formalized process• Clinical pharmacists
– Target drug reports– Patient care rounds
• Restrictions– Infectious Diseases, Intensive Care Unit, or
specialty physicians• High utilization of RADs
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3. What is the RAD pre-printed order (RAD PPO)?
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RAD PPO
• VCH Quality and Patient Safety, ASPIRES, and Pharmacy • Facilitate prescribing of
ceftAZIDime, daptomycin, linezolid PO/IV, meropenem (or formulary carbapenem), and tigecycline
in accordance with provincial criteria;– Educate clinicians on restrictions; – Prompt clinicians to consider narrower spectrum agents;– Evaluate appropriate use of these agents
• Launched on Jan 26, 2015 at VGH
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RAD PPO
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4. What are challenges when developing and implementing a
RAD PPO?
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Challenges
• Promotion of concept • Stakeholder support
– Heads of Medicine/Surgery– Medicine/Surgery– Pharmacy & Therapeutics & Medical Advisory
Committees– VP Medicine
• Perception of increased workload– Prescribers, Pharmacy, Nursing, Nursing Unit Clerks
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Challenges
• Development of policy– Workflow
• Prescriber, Pharmacy, Nursing
• Communication– Newsletter and memos
• Education– Pharmacy staff– Prescribers– Nursing Unit Clerks
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5. How do we evaluate a RAD program?
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Evaluation
• Compliance• Utilization• Anti-infective consumption• Staff and prescriber feedback
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Evaluation
Reserved Antimicrobial Drugs Pre-printed Orders Completed During Week 1, Jan 26 to Feb 2, 2015
New RAD Prescriptions RAD PPO completed RAD PPO sent to ward RAD PPO not sent
23164 3
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Reserved Antimicrobial Drugs PrescribedDuring Week 1, Jan 26 to Feb 2, 2015
Meropenem 20
Linezolid 2
Ceftazidime 1
Daptomycin & Tigecycline 0
6. What are lessons learnt from the RAD program?
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Lessons Learnt
1. Support from leadership– Meet with key opinion leaders
2. Stakeholder acceptance– Persevere– Engage stakeholders in development
process
3. Simple to use– Complement workflow
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What does this mean for patients?
• Think before prescribing• Reduce unnecessary broad-spectrum agents• Educate and support physicians at point of
