Page 20 - Christiana Care Focus June July 2018

Stewardship | Usingantibioticswisely C O N T I N U E D
includeJillianDougherty,Pharm.D.,BCPS, clinical pharmacy specialist, Infectious Diseases; Julianne Gardner, Pharm.D., clinicalpharmacyspecialist,Infectious Diseases; and Ken Silverstein, M.D., MBA, chief clinical officer and a strong advocate for Choosing Wisely.
“We are moving on many levels because everything is connected, whether it is inpa- tient care, outpatient care or nursing home care,” said Dr. Drees, who is working on implementing Choosing Wisely for ambu- latory patients. “We have to address the use of antibiotics with clinicians and patients throughout the health care system if we are to be effective at reducing the inappropriate use of these medications in Delaware.”
“In general, both patients and providers have recognized that antibiotic overuse is a problem — but they may have thought, ‘It’s not my problem.’
Marci Drees, M.D., MS, FACP, DTMH
In 2015, the “National Action Plan for Combating Antibiotic-Resistant Bacteria,” written under the Obama administration, set a goal for all hospitals to have antibiotic stewardship programs to help reduce inappropriate antibiotic prescriptions
by 20 percent by 2020. Already, the Joint Commission, which accredits and certifies nearly 21,000 health care organizations, has begun to include antibiotic stewardship in its standards.
In February, Dr. Kramer presented data on the success of the Medical Aid Units in meeting Joint Commission standards during a CMS (Centers for Medicare & Medicaid Services) Quality Conference in Baltimore. The latest data for the Medical Aid Units show:
• WhencomparingtheperiodofJanuary- to-June 2017 to July-to-December 2017, the total use of antibiotics decreased by 25 percent.
• Inthesamecomparisonperiod,thetotal use of azithromycin decreased by 44 percent.
• Theantibioticprescriptionratedecreased to 35 antibiotics per 100 visits in March 2018, compared to 67 per 100 visits in December 2016, before the intervention was implemented. That’s a decrease of 48 percent.
Specifically, the azithromycin prescription rate decreased to three antibiotics per 100 visits in March 2018, compared to 13 per 100 visits in December 2016. That decrease is a drop of 77 percent.
Dr. Kramer says that the antibiotic intervention has achieved medicine’s Quadruple Aim of improving quality and safety, reducing costs, enhancing the patient experience and, as providers observe the continuous improvement in care, making medicine a more joyful experience for clinicians.
thereisaPatientCommitmentLetter posted in the Medical Aid Units and signed by Christiana Care Medical Aid Unit Providers.Theletterreads:“Thankyoufor allowing us to be partners in your care. We promise to treat your illness in the best way possible. We are committed to prescribing antibiotics responsibly and only when needed.”
Antibiotic stewardship at a glance
Antibiotic stewardship is an effort to improve antibiotic use by clinicians and patients so that antibiotics are only prescribed and used when needed.
Patient education is vital. Videos, brochures and posters in a medical office reinforce
the positive message that clinicians are sending about making the right diagnosis and providing the right medication for the right duration.
When a patient expects an antibiotic, it is important to validate the patient’s reasons for seeking help even if their complaint won’t be helped by the medication being sought. “I can see that you are suffering from a bad cold and very much want relief. However, an antibiotic is not going to re- lieve your symptoms since your infection is viral. Let’s find what will work best for you.”
It is also helpful to inform patients about efforts by the U.S. Centers for Disease Control and Prevention to avert a health care crisis through the appropriate use of antibiotics. This is a national priority, for any time antibiotics are used they can cause side effects and lead to antibiotic
bacteria have become resistant to the antibiotics designed to kill them.
And when bacteria become resistant, antibiotics cannot fight them, and the bacteria multiply. Some resistant bacteria can be harder to treat, leading to increased hospitalizations and morbidity. 
18 CHRISTIANA CARE HEALTH SYSTEM
“What Dr. Kramer has done is groundbreaking at Christiana Care, and it is a credit to his leadership,” said Dr. Dressler, who hopes to see more analytic data on how best to implement antibiotic stewardship to foster even greater improvement throughout the hospital system.
W
collaboration is important
ithin the Medical Aid Units there is agreement among the 30 providers that close
to bring about antibiotic stewardship.
The team has also engaged in lots of basic education for patients who often expect to be given an antibiotic for viral infections.
“It helps to have brochures, posters in the waiting room and displays in the exam room on proper antibiotic use and to point out that the CDC has made reducing the inappropriate use of antibiotics a national priority,” said Dr. Kramer, who adds that changes are being made without any compromise to the health of patients.
The clinicians work on disease protocols
to make sure a diagnosis is correct, the antibiotic choice is correct and the duration of treatment is correct. And it helps that
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