990. Clinical Microsystems Approach to Antimicrobial Stewardship (ASP) at A Large Tertiary Care Hospital
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA 2013 Poster Presentation Number 990.pdf (571.4 kB)
  • Background:

    There are many quality improvement tools in the quality assurance (QA) toolbox available to medical organizations.  We recognized the ASP as a clinical microsystem as it is a place where “care is made; quality, safety, reliability, efficiency, and innovation are made; and staff morale and patient satisfaction are made.”  Our institution chose a Clinical Microsystems approach to create our Antimicrobial Stewardship Program.


    We began with an in-depth study of the present ASP clinical microsystem.  We identified the purpose of ASP, which came down to: right drug for the right bug, at the right dose, for the right duration and correct indication. We use the EPIC electronic medical record product in our institution and TheraDoc’s clinical surveillance tool. Our target population includes all inpatients on antimicrobials.  Any prescriber of antimicrobials was our microsystem professional.  We found many processes on first pass mapping with many different patterns of prescribing.  We continued to study the microsystem until we were able to focus on the ASP patient care fractal: pharmacist – patient – medical professional (MD/DO/PA/NP).  We began educating the pharmacist/medical professionals on the role and purpose of the ASP.  We started with small tests of change from centralized ASP rounds eventually extending to our goal of end users employing a clinical surveillance tool to enable, empower, and make these changes a part  of the workflow.


    Average monthly Pharmacy interventions: PRE ASP : 760, and POST ASP 845.  Additional intervention with use of TheraDoc: 210/month with 84% response rate.  Cost avoidance per month since ASP started: $150,650.  Cost avoidance since starting ASP to date: $2,259,724.  SFMC Pharmacy Cost per antibiotics per month PRE formal ASP: January 2011 - $948,468.79; and POST formal ASP development: January 2013 - $653,049.21  Improved pharmacy/health professional satisfaction survey scores.


    The use of a Clinical Microsystems approach for ASP has been successful at our institution.  We eliminated waste (de-escalation), improved workflow and optimized time (decentralized ASP to end users), changed the work environment of ASP to one that assists without dictating choices, and managed variation by standardizing the responses to TheraDoc’s clinical surveillance tool alerts.

    John Cotter, MD MPH, Medicine, University of Illinois College of Medicine - Peoria/OSF SFMC, Peoria, IL


    J. Cotter, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.