1003. Early Development of a Provincial Antimicrobial Stewardship Support Model:  A Needs Assessment Survey of Ontario Hospitals
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

In 2011, Public Heath Ontario (PHO) was funded to establish a provincial antimicrobial stewardship program (ASP). That year, PHO, in partnership with the Ontario Hospital Association, surveyed provincial needs to determine objectives. In 2012, Accreditation Canada deemed ASP a required organizational practice (ROP) to begin Jan 2013. A second survey was issued to ascertain hospital level of preparedness.

Methods:

A 20-item survey was electronically distributed to all Ontario hospitals Sept 2011. A follow-up survey to determine hospital preparedness was issued May 2012.

Results:

Of 149 centers, 122 (82%) responded in 2011: 16 (13%) academic centers, 91 (74%) community hospitals, and 11 (9%) complex continuing care centers. Only 39 (32%) had an ASP. Forty (48%) were considering an ASP while 10 (12%) more had an ASP business case. Of those without an ASP (n = 83), only 18% had resources for a program. Of those with an ASP (n = 39), 62% confirmed designated resources. ASP members included infectious disease (ID) pharmacists (38%), non-ID pharmacists (59%), ID physicians (54%), non-ID physicians (13%), and infection control practitioners (38%). Common tools were antibiograms (85%), clinical pathways/guidelines (72%), antimicrobial utilization tracking (64%), and order sets (62%). Despite current guidelines, only half of ASPs used audit & feedback (56%) or formulary restriction/prior authorization (56%). Among all (n=122), resource limitations were evident; on-site access to ID physicians (28%), ID pharmacists (20%), and information technology support (24%) was uncommon. Computerized physician order entry and integrated lab & pharmacy data (bug-drug mismatch) were rare (13-16%). Participants felt a provincial ASP should include in-person conferences (44%), webinars (43%), and skills workshops (60%), with less emphasis on lectureship (13%) or print materials (12%). Desired resources included professional development (69%) and dedicated time (79%). In 2012, only 22% were confident they would meet the ROP; 9% were unaware of the requirements.

Conclusion:

In 2011, only 32% of Ontario hospitals had an ASP. PHO, charged with creating a provincial ASP, will need to improve access to expertise, conduct in-person skills development, and explore the expansion of ASP endeavours to support hospitals with limited resources.

Pavani Reddy, MD, Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada; Division of Infection Control and Prevention, Public Health Ontario, Toronto, ON, Canada, Colleen Nisbet, RN MHSc, Clinical Service, Simcoe Muskoka District Health Unit, Barrie, ON, Canada, Liz Van Horne, CIC, Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada, Sudha Kutty, Patient Safety, Physician, and Professional Issues, Ontario Hospital Association, Toronto, ON, Canada, Karen Sequeira, Patient Safety, Ontario Hospital Association, Toronto, ON, Canada, Camille Lemieux, BSc Phm, MD, Infection Prevention and Control, University Health Network, Toronto, ON, Canada and Gary Garber, MD, FACP, FIDSA, Public Health Ontario, Ottawa, ON, Canada; Division Of Infectious Diseases, Ottawa Hospital, Ottawa, ON, Canada

Disclosures:

P. Reddy, None

C. Nisbet, None

L. Van Horne, None

S. Kutty, None

K. Sequeira, None

C. Lemieux, None

G. Garber, None

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