Changing the Culture: Spreading the Stewardship Message to a New Campus
Background: As of 2014, the CDC recommends that all acute care hospitals implement Antimicrobial Stewardship Programs (ASP). Montefiore is an academic medical center with 1490 beds and ASP since 2008. Recently, Montefiore acquired a new campus, a 369-bed acute care facility in the community with no formal ASP. A review of prescribing from 2010-2013 showed a disproportionally large consumption of IV antimicrobials, particularly quinolones. In 2013 an ID physician and ID pharmacist were hired to extend Montefiore ASP to the new campus.
Methods: ASP launched in December 2013 adapted from existing policies at Montefiore but tailored to our patients, prescribers, and pathogens. Target activities include 1) prior authorization, 2) audit and feedback at 72-hours, 3) formal ID consult for drugs of “last resort”, 4) IV to PO switch, and 5) education. Prior authorization occurred on weekdays from 8am to 5pm. During off hours, pharmacy authorized antibiotic doses until the next business day with ASP follow up. Initial activities and process measures from 12/13 to 3/14 are described, including purchasing data (defined daily doses [DDD] per 1000 admissions).
Results: 224 pager requests and >500 audit interactions were reviewed from 1/14 to 3/14. Overall approval rate was 75%, however only 15% were approved as requested, and adjustments were made to the remaining 85% (i.e. dose, route, duration, suggestion of alternate regimen or work-up). Approval-rate varied by drug. 77% of new requests for IV ciprofloxacin resulted in an alternative regimen due to high rates of gram-negative resistance in New York City. IV to PO switch was successful in 41% of azithromycin and 50% of levofloxacin requests. ID consults were recommended in 75 of 224 interactions (33%), and 69% of these occurred within 3 days. Formal educational outreach was provided to diverse services of >100 prescribers. Monthly DDD/1000 admissions for 4 high volume antibiotics pre- and post ASP onset (12/12-3/13 vs. 12/13-3/14) is shown in below.
Conclusion: Our early data suggests an impact on antibiotic volume and selection by outreach to large groups of prescribers. Adaptation of the traditional academic ASP model appears successful when applied to a community hospital.
J. E. Williamson,
M. Corpuz, None
I. Munjal, None
Y. Guo, None
P. Chung, None
B. Ostrowsky, None