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This presentation was delivered in session F1 of Quality Forum 2014 by: Victor Leung Infection Prevention & Control Physician Providence Health Care Clinical Assistant Professor, Pathology and Laboratory Medicine UBC
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Building an antimicrobial stewardship program by engaging
prescribers
Dr. Victor Leung, MD FRCPC
SEX AND THE SUPERBUG
The rise of drug-resistant gonorrhea. BY JEROME GROOPMAN
CONSEQUENCES OF INAPPROPRIATE ANTIBIOTIC USE
We have an opportunity to delay the post-antibiotic era and optimize patient outcomes by improving antibiotic
prescribing behavior
SUSCEPTIBILITY GUIDED
PATHOGEGN DIRECTED EMPIRIC PROPHYLACTIC
Optimize Antimicrobial
Use Education
Academic Detailing
Diagnostic test utilization
Data collection +
analysis Research
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
Optimize Antimicrobial
Use Education
Academic Detailing
Diagnostic test utilization
Data collection +
analysis Stewardship Infrastructure
Collaboration with
prescribers
Formulary restrictions
Systematic and coordinated approach to using appropriate antimicrobial agents to achieve optimal outcomes
Educational Journal Club Events Reached over 100 Prescribers
Optimize Antimicrobial
Use Education
Academic Detailing
Diagnostic test utilization
Data collection +
analysis Stewardship Infrastructure
Collaboration with
prescribers
Formulary restrictions
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
Optimize Antimicrobial
Use Education
Academic Detailing
Diagnostic test utilization
Data collection +
analysis Stewardship Infrastructure
Collaboration with
prescribers
Formulary restrictions
Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes
0
50
100
150
200
250
300
BF HFH Youville Lanagara
Num
ber o
f Urin
e Cu
tlure
s
Residential Care Facility
2009
2010
2011
2012
2013
Urine Cultures from PHC Residential Care Facilities are Decreasing
21
Optimize Antimicrobial
Use Education
Academic Detailing
Diagnostic test utilization
Data collection +
analysis Stewardship Infrastructure
Collaboration with
prescribers
Formulary restrictions
Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes
$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
ActualExpenditures
BudgetedExpenditures
Optimize Antimicrobial
Use Education
Academic Detailing
Diagnostic test utilization
Data collection +
analysis Organizational Structure
Collaboration with
prescribers
Formulary restrictions
Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes
Optimize Antimicrobial
Use Education
Academic Detailing
Diagnostic test utilization
Data collection +
analysis Stewardship Infrastructure
Collaboration with
prescribers
Formulary restrictions
Systematic and coordinated approach to using antimicrobial agents to achieve optimal outcomes
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&drugs@providencehealth.bc.ca
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