STFM Anti Microbial Stewardship programme.pptx

AMS

1. Foundations of an Outpatient Antimicrobial Stewardship Program Brian Stello MD, Eric T. Young MD, Jarrod W. Kile RPh BCPS, Timothy J. Friel MD, Grant M. Greenberg MD MHSA MA, Tibisay Villalobos MD, Kristin Held Wheatley PharmD BCOP, Katarzyna Jabbour PharmD BCPS, Kathryn Zaffiri MPH. Lehigh Valley Health Network, Allentown, PA (610-402-LVHN, LVHN.org) 1

2. Disclosures The authors and contributors have no financial relationships to disclose. 2

3. Setting This presentation describes the development and progress of an outpatient antimicrobial stewardship (AMS) program at a large northeastern healthcare network among over 80 outpatient Primary Care (FM, GIM, Pediatrics) and Express Care practices. 3

4. Component 1. Leadership Committment Authority to establish outpatient AMS arises from the Chief Medical Officer, who supported the establishment of the program. Multidisciplinary operational leadership comes from key clinical departments: Pharmacy, Infectious Disease, Primary Care (Medicine, Family Medicine, Pediatrics), Express Care. Other specialty support is incorporated as needed. 4

5. Component 2: Local Antibiograms Provide up-to-date patterns of antimicrobial local resistance and sensitivities 5

6. Component 3: Treatment and Prophylaxis Guidelines Develop pathways recommending empiric antibiotics when the pathogen remains unknown. Limiting unnecessary use of antimicrobials pre-procedure with prophylaxis guidelines Avoid antibiotics with guidelines for conditions likely to be viral (e.g. URI, sinusitis, bronchitis, non-Strep pharyngitis) 6

7. Component 4: Patient Education Provide information for patients on appropriate use of antimicrobials; we use information provided by the Centers for Disease Control Engage in Shared Decision-Making with patient seeking unnecessary antibiotics on risks and benefits. 7

8. Component 5: Immunizations Evaluation of emerging immunizations for use in clinical practice Education on revised immunization practices Targeting under-immunized populations among adult and pediatric populations 8

9. Component 6: Audit & Feedback Measure and reporting rates of inappropriate antibiotic prescribing for diagnoses known to have antibiotic overuse Set network targets for avoidance of antibiotics for those conditions Develop multilevel reporting for clinical departments, outpatient practices, and individual practitioners 9

10. Component 7: Clinical Education Develop Grand Rounds to develop vision for Stewardship Provide access to physical and virtual Antimicrobial Guides Distributed pulsed education such as emails and push notifications to practitioners Provide embedded electronic resources for use during patient encounters 10

11. Results Subhead 11

12. Results Three-year trend lines for the outpatient program demonstrate decline of inappropriate antibiotic prescribing The avoidance of in appropriate prescribing among top performing practices are displayed in the bar graph. (For more detailed data, please use the QR Code) 12

13. References CDC, NCEZID, DHQP. Core Elements of Outpatient Antibiotic Stewardship [database on the Internet], last reviewed November 14, 2019. Kohut MR, Keller SC, Linder JA, Tamma PD, Cosgrove SE, Speck K, Ahn R, Dullabh P, Miller MA, Szymczak JE. The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting. Family Practice 2019, Nov 6. pii : cmz066. doi : 10.1093/ fampra /cmz066. [ Epub ahead of print] Durkin JM, Jafarzadeh SR, Hsueh K, Sallah YH, Munshi KD, Henderson RR, Fraser VJ. Outpatient antibiotic prescription trends in the United States: a national cohort study, Infection Control and Hospital Epidemiology. 2018 May;39(5):584-589. 13

14. For more information [email protected] [email protected] 14