The Oregon Antimicrobial Stewardship Initiative (OASIS)

Background:

Inappropriate use of antibiotics may be related to increases in multidrug resistant organisms (MDROs) and Clostridium difficile infections (CDI). Unfortunately, there are few new antibiotics in development to treat increasingly resistant infections. We implemented OASIS as a statewide model to develop antimicrobial stewardship programs (ASP) for hospitals.

Methods:

All Oregon hospitals were asked to complete an online survey to assess ASP baseline practices. Thirteen hospitals committed to participate in OASIS, providing antimicrobial utilization and cost data to the Oregon Patient Safety Commission (OPSC), along with a monthly logbook of pharmacy recommendations and outcomes.

The collaborative provided hospital teams with 3 learning sessions focused on core ASP strategies and program development tools. Participants selected their own interventions of greatest impact based on CDC recommendations for ASP. Pharmacy and therapeutic committees at each hospital approved ASP implementation and guidelines. The OPSC provided a secure web-based platform where hospital teams can view guidelines, updates and directly upload data on a monthly basis. Other educational support includes weekly “Drugs & Bugs” calls to an Infectious Disease Consultant (IDC), webinars, conference calls, and site visits.

Results:

Of the 13 participating hospitals, 2 are pediatric and 3 are critical access. The table below displays the number (n) of recommended interventions accepted by providers since January 2013. Seven of 13 hospitals (54%) are providing antimicrobial utilization data while 6 are still facing challenges with adequate IT support and/or complex pharmacy systems.

 

Recommended Interventions	Total (n)	% Acceptance
Discontinue Anaerobic Double Coverage	12	91.7%
ID Consult Suggested	31	48.4%
Discontinue Antimicrobial Prescription	67	80.6%
Narrow Spectrum of Activity	94	77.7%
Intravenous to Oral switch	105	91.4%
Dose Change	199	97.0%
Other	155	73.5%
Overall	663	93.8%

 Conclusion:

OASIS has provided educational tools and resources for initiation and maintenance of ASP for Oregon hospitals. There has been a high rate of acceptance amongst providers participating in OASIS. Lack of adequate IT support for cost and antimicrobial utilization data is a limitation that is being addressed.