Background: In 2013 Accreditation Canada identified an Antimicrobial Stewardship Program (ASP) as a Required Organizational Practice in all acute care hospitals. A successful antimicrobial stewardship program is inter-disciplinary and involves clinical pharmacists as a key member of the team. This small rural acute care hospital utilizes a telepharmacy model of care with a remote clinical pharmacist.
This hospital is a 20- bed acute care hospital with no on-site clinical pharmacist and has been utilizing Telepharmacy services since 2008. To prepare for Accreditation in December 2013, the remote clinical pharmacist was requested to support and lead the antimicrobial stewardship program.
Methods: The remote clinical pharmacist performed a gap analysis to identify areas requiring improvement for a successful ASP which included the need for an Antimicrobial Stewardship committee, an IV to PO conversion program for antibiotics, development of guidelines and clinical pathways for common infections, hospital specific antibiogram, and prospective audit with intervention and feedback. The remote clinical pharmacist participated in meetings with nurses, physicians and other key stakeholders using videoconference technology to develop a plan for the ASP. The remote clinical pharmacist started prospective data collection in September 2013. Starting January 2014, the remote clinical pharmacists started providing prospective audit with intervention and feedback.
The antimicrobial stewardship program was formally accepted by Accreditation Canada in December 2013.
Figure1 Days of Therapy (DOT) per 1000 Patient Days Over 4 Years
Conclusion: Small rural and remote acute care hospitals without access to an on-site clinical pharmacist can successfully implement and maintain an ASP by seeking support from experienced remote clinical pharmacists.
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