Date post: | 20-Aug-2015 |
Category: |
Health & Medicine |
Upload: | bcpsqc |
View: | 376 times |
Download: | 1 times |
The New World of Stewardship Jim Hutchinson
Medical Director - Antimicrobial Stewardship Island Health
Clinical Lead – Antimicrobial Stewardship BCPSQC
Required Organizational Practice: The organization has a program for
antimicrobial stewardship to optimize antimicrobial use.
BC Ministry of Health
• New Clinical Care Management area • Established Provincial Antimicrobial
Clinical Expert group
PACE
• Co-Chaired by Richard Bachand and I with ministry support
• Established in spring 2013 • Aggressive work plan
PACE activities
• Best practice review completed • Survey of stewardship capacity completed • Business case RFP out • Assuming responsibility for the Antibiotic /
Probiotic portions of the Provincial Hospital Formulary
PACE activities
• Best practice review completed • Survey of stewardship capacity completed • Business case RFP out • Assuming responsibility for the Antibiotic /
Probiotic portions of the Provincial Hospital Formulary
Which targeted antimicrobial stewardship activities are done at this facility?
0% 10% 20% 30% 40% 50% 60% 70% 80%
Other
Prospective Audit with Intervention and Feedback
Pre-Authorization
Guidelines and Clinical Pathways
Education Program
Formalized IV to PO Conversion Program
Time-sensitive Automatic Stop Orders
26
Which targeted antimicrobial stewardship activities are done at this facility?
0% 10% 20% 30% 40% 50% 60% 70% 80%
Other
Prospective Audit with Intervention and Feedback
Pre-Authorization
Guidelines and Clinical Pathways
Education Program
Formalized IV to PO Conversion Program
Time-sensitive Automatic Stop Orders
27
Prospective Audit with Intervention and Feedback By Health Authority
0
1
2
3
4
5
FHA IHA NHA PHC PHSA VHCA VIHA
Num
ber o
f Fac
ilitie
s
Clinical Pharmacy backbone
• Clinical Pharmacists are the “Foot Soldiers”
• We don’t have enough • We MUST build capacity
Centralized medical oversight
• Infection specialists (ID and Medical microbiologists) provide direct and responsible collaborative help to clinical pharmacists.
• This is not the usual model of physician interaction and oversight
Multidisciplinary help the process • Clinical pharmacists find people with
infections – By antibiotic prescription – By microbiologic Dx – By algorithm
• Advise on their management in collaboration with Specialist physician
• Follow-up
Multidisciplinary help the process
• Trust must be established • Collegial, educational, non-punitive • Direct physician to physician interaction
very important at the outset
Unsolicited Help Clinical pharmacists hired in:
• Nanaimo • Campbell River • Cowichan District • Victoria
Unsolicited Help
• They have found hundreds of patients • They have phoned me (and my
colleagues) many, many times • They have helped!
PACE activities
• Best practice review completed • Survey of stewardship capacity completed • Business case RFP out • Assuming responsibility for the Antibiotic /
Probiotic portions of the Provincial Hospital Formulary
Which of the following metrics are used to evaluate antimicrobial usage?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Defined Daily Dose Days of Therapy Length of Therapy Total Cost ofAntibiotics
None Other
45
SEISMIC Surveillance and Epidemiology of Infections, Stewardship, Microbiology, and Infection Control
A Quality Assurance & Surveillance Analytical
Environment for Microbiology, Antibiotic Stewardship and Infection Control
“a roadmap for the development of enhanced clinical
analytical capacity within Island Health”
SEISMIC
• Extension of the Business Intelligence Data Warehouse
• Re-purposing transactional data to facilitate quality care
What data is needed for quality management of infections? • Antibiotic use • Antibiotic resistance
– “Antibiogram” • Measures of inflammation
– e.g. WBC, Temperature, Procalcitonin • Outcome measures
– e.g. LOS, mortality, complications, readmissions
Future of SEISMIC
• Relate antibiotic use to resistance • Relate antibiotic use to outcomes • Predict appropriate empiric therapy by
personal microbiologic history • Etc., etc., etc.
The ultimate vision
• All people on Vancouver Island will have their infections anticipated, prevented, diagnosed and treated in a thoughtful, efficient, SYSTEMATIC fashion.
The ultimate vision
• All people in British Columbia will have their infections anticipated, prevented, diagnosed and treated in a thoughtful, efficient, SYSTEMATIC fashion.