Professional Pharmacy Focus: Hospital's medication management/tracking tool helps antibiotic program
Hospital's medication management/tracking tool helps antibiotic program
Precise vancomycin use is tracked
Bon Secours Maryview Medical Center of Portsmouth, VA, uses an electronic medication management tool to track all interventions involving vancomycin use, as part of an antimicrobial stewardship program.
"We track interventions in antimicrobial stewardship," says Carol Carson, PharmD, BCPS, clinical pharmacy specialist at Bon Secours Maryview. Carson also is the system administrator for the medication management tool Quantifi for 14 hospitals across six states for the Bon Secours Health System.
"We know we have a strong vancomycin dosing service," Carson says. "But we want to make sure pharmacists get the proper literature on how to dose vancomycin, including the new paper out from the Infectious Diseases Society of America (IDSA)."
For example, when a sister hospital saw the latest IDSA paper, pharmacists realized their target levels for vancomycin weren't high enough, and so they upped the levels, Carson explains.
Pharmacists dose nearly all vancomycin orders at Maryview, Carson says.
"And if we don't dose it, then the medical staff has given pharmacists the authority to monitor it and order labs if the physician doesn't order them," she adds. "Pharmacists can intervene if we need to, especially if a physician hasn't done a dose level according to our policy."
The health system's electronic medication monitoring system has made it possible to calculate that when an intervention involves the sepsis drug drotrecogin alfa (Xigris®), the savings is $13,000 per intervention if the drug is not used.
"Some hospitals find it very hard to rein in those Xigris costs because of indiscriminate use," Carson notes. "But at Bon Secours Maryview, any physician who writes an order for Xigris will have the pharmacy review his work to see if the patient is an appropriate candidate."
If the patient doesn't meet criteria for the expensive drug's use, then the patient is not given the drug and the case is documented as an intervention with cost savings, she adds.
The antimicrobial stewardship program was started in January 2009 and after four months of data were available, the information was analyzed and submitted as an abstract for presentation at the 2009 American Society of Health System Pharmacists Mid-Year Meeting, Carson says.
The data indicated that about 53% of the hospital's antimicrobial use was appropriate, Carson says.
"We found that fluoroquinolones were misused, and then we found inappropriate antibiotic use in patients with respiratory illnesses who had no signs or symptoms of infection," she adds. "We found failure to order multiple sets of diagnostic blood cultures, and that's very important."
The latter finding led to an educational intervention when it was discovered that physicians thought they were ordering two sets of blood cultures, but were actually only ordering one on the computer, Carson explains.
"So we educated the physicians on how to order it correctly," she says.
The antimicrobial stewardship program consists of pharmacists assisting an infectious diseases physician who has a part-time position at the hospital.
"We partnered physicians and pharmacists in processes using automated technology in developing a prospective audit and feedback system to prescribers," Carson says. "The ID specialist writes up a communication, and then we look at those communications to see how they were handled by prescribers."
The infectious diseases doctor determines whether the antimicrobial use was appropriate, and pharmacists relay this information to attending physicians, says John Austin, PharmD, a clinical pharmacist at Bon Secours Maryview.
"These communications are placed on the chart for the physician to review," Austin says. "On occasion there might be one that's urgent and needs immediate response, and in those cases I call the physician right away."
"We monitor to see if that particular suggestion has been addressed by the attending physician," he says.
The recommendations typically are printed out and put in the chart where they remain in the chart and become a permanent part of the chart, Carson says.
Bon Secours Maryview Medical Center of Portsmouth, VA, uses an electronic medication management tool to track all interventions involving vancomycin use, as part of an antimicrobial stewardship program.Subscribe Now for Access
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