Home' The Source : First Quarter 2015 Contents pathways for conditions that include skin/soft tissue
infections, urinary tract infections, acute bacterial
meningitis, pelvic inflammatory disease, prosthetic
joint infections and sepsis. It also produced eight
sets of pharmacy-based guidelines on topics such as
antibiotic catheter lock, antibiotic allergies, systemic
antifungal therapy and vancomycin.
Initially, the team printed and distributed hard
copies of the pathways and guidelines it created---
today they're all online, posted on a BMC intranet
and accessible directly in the EHR so physicians can
see the rationale behind the antibiotics included in
the order sets.
Once a week, the team meets to review progress
on initiatives and other data, such as antibiotic usage
and cost, to assess the need for guidelines, pathways
or quality improvement projects, such as the one
resulting in a pneumococcal vaccine protocol and algorithm. It also
checks in with other departments, such as infection control, to get
data that might help the team choose the next target for intervention.
Additionally, the team reviews benchmarking data available through
BMC's membership with the University HealthSystem Consortium
(UHC) and HealthTrust.
"The HealthTrust data we can access through the inSight tool
is definitely more operational and purchase-based than what
we receive through UHC, but the data can still tip us o to high-
expense areas to target," says David Twitchell, PharmD, MBA, chief
pharmacy o cer.
From Retrospective to Prospective
Now that many of the guidelines, pathways and policies are in place,
the team is moving toward more patient-level recommendations and
employing a prospective audit and feedback method allowing it to
help clinicians make real-time drug decisions.
"At fi rst, the antimicrobial stewardship program was largely a
retrospective, big-picture review of past usage and misadventures,
trying to educate people to do better in the future," Twitchell says. "We
did not have a well-defined system for real-time review of patients'
charts and prospective intervention. Today, we're targeting areas of
misuse, and reports issued each morning enable Dana and Kelly to
As the program plays a bigger and more direct role in patient care,
Twitchell emphasizes the importance of open communication and
physician support. "As much as it may pain a pharmacist to hear,
having a physician champion is critical," he says. "Getting sponsor-
ship is much easier than continuing to fight with a physician who is
constantly pushing back."
The team is developing a physician report card to show providers
how they're performing against standards of care and their peers.
TEAMWORK TOOLS MEMBER SUCCESS STORY
Continued from page 38
With 496 beds, its own infectious
disease center and a post-graduate
pharmacy residency track in infectious
diseases, it's no wonder that Boston
Medical Center (BMC) has such a robust
antimicrobial stewardship program. The
program even spawned a five-week rota-
tion specific to antibiotic stewardship.
But it wasn't always that large---nor
does it need to be to make an impact,
says David Twitchell, PharmD, MBA,
chief pharmacy o cer at BMC. "There's
no hospital too small to have a program
like this. Start somewhere and take steps
toward improvement today."
Here are some of Twitchell's recom-
mendations for starting an antibiotic
stewardship program in your facility:
• Convert eligible patients from intra-
venous to oral medication therapy. This
was one of the first steps taken by BMC's
antimicrobial stewardship team. "It's low-
hanging fruit because it's easy to do and
generates cost savings," Twitchell says.
• Create your own clinical pathways or
guidelines. If you don't know where to
start, contact the HealthTrust Pharmacy
team. "The team won't do the research
for you, but they'll point you in the right
direction," Twitchell says. "The clinical
expertise at HealthTrust can be enor-
mously helpful to members."
• Bring your results to the C-suite to
help convince them that more resources
'No Hospital Too Small'
Advice for Antimicrobial Stewardship at Your Facility
Left to right: Dana Whitney, Tamar Barlam, David Twitchell and Kelly Wright, leaders of
Boston Medical Center's antibiotic stewardship program
40 The Source | First Quarter 2015
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