My Favorite VigiLanz Rule: Pharmacists and IPs Share Their Top Picks

At VigiLanz, data rules! And as a VigiLanz customer, you can create more actionable data by tapping into our extensive rules library or creating new rules based on your unique needs. Our clinical experts are always standing by to help, whether you need help adjusting an existing rule or creating something new.

We’ve gathered some inspiration from real VigiLanz customers on their favorite and unique VigiLanz rules that have a significant impact on patient care.

 


Biofire Alert

Jeremy Frens, PharmD, BCPS-AQID, Antibiotic Stewardship Coordinator at Cone Health

“My favorite rule is the positive Biofire alert. We have customized the alert so that our antimicrobial stewardship team and ID physicians get email or text alerts based on the organism detected. Our hospital has a policy that an ID physician sees patients with Staph aureus, Candida, or enterococcal bacteremia. With the text or email alerts going directly to them, they can respond quickly, often the same day as the alert. We feel that this process helps to streamline antibiotics more quickly!”


High Risk C. difficile

Erica Lawrence, MSN, RN, Infection Preventionist at Virginia Mason Medical Center

“My favorite one is the high risk C. difficile rule. This rule helps to alert us proactively of patients at risk for C. difficile, but not necessarily diagnosed or symptomatic with C. diff. This allows for the AMS group to review prescribed medications and make recommendations to the providers if de-escalation of antibiotics or gastric acid suppressors is appropriate. Another intervention is adding signs and symptoms of C. difficile to the discharge instructions to ensure patients are educated about when to follow up with their provider if signs and symptoms of C. difficile begin after discharge.”


Critical Medication Discontinued

Jill Bennett, PharmD, APh, BCPS, Clinical Pharmacy Coordinator at Antelope Valley Hospital

“Some of my favorite rules are the ones that alert us to medications that have been discontinued when that might be detrimental to a patient outcome. For example: Levetiracetam DC’d and no active anticonvulsant order, or in patients with prolonged LOS when routine medications may fall off the profile from an ASO: Inpatient Day #30 – Check Med Profile. The real-time culture info is also nice.”


Patient Discharge SNF

Chrissie Wiebe, Infection Preventionist at Maury Regional Medical Center

“I would have to say my favorite rule we have is the “Pt Discharge SNF (CMP-QI Grant Locations)”. I like this rule because we are able to track patients who are going to certain nursing homes at discharge using keywords in their documentation. This rule is helpful because we have a grant that is allowing us to work with certain local nursing homes to help prevent readmission. This rule allows us to know which patients are going to these locations so we can get a better idea as to where our patients are going and how we can best serve the SNF’s in order to prevent a possible readmission for something they can take care of at their facility.”


Highly Infectious Disease Email Alerts

Jordan Ehni, CIC, MPH, Systems Integration Infection Preventionist at Mount Sinai Health System

“I think my favorite rule/function are the email alerts that we can set up for when a patient with a highly infectious disease comes into the hospital. We don’t have time to constantly check VigiLanz throughout the workday, so it is good to know we have this ‘back up’ alert if we go a few hours between checking our Isolation Bucket.”


Highly Infectious Disease Email Alerts

Sarah Lowtharp, MSN, RN, CIC, Assistant Director of Infection Prevention at St. Bernards Medical Center

“My favorite rules are centered on alerting us of highly infectious patients immediately. I get an email alert from a rule trigger in VigiLanz on possible meningitis, possible TB, CROs, and possible Candida auris (the Candida isolates we are required to send to dept. of health for auris testing). I usually receive my email/VigiLanz alert before our own lab notifies us of these scenarios.”

 


Real-Time Blood Culture Contamination Results

Frank Vanskike, MPH, CIC, Infection Preventionist at Phoenix Children’s

“We worked with our VigiLanz team to build a rule around blood culture contamination results in our ED. These reports alerted us in real-time as opposed to the previous method where we were provided the contamination rate at the end of the month. We were able to build a report off of the rule and disseminate to the ED and stakeholders on a weekly basis. This intervention helped us track when and where contamination on blood draws were occurring so real-time education and feedback could be provided. Furthermore, this helped the ED because the report enabled us to communicate to the ED patients that had contaminated specimens that were not true infections and did not need to return to the ED to seek treatment. This saved a return visit to the hospital for families, avoided potential readmissions, prevented unnecessary antibiotic use, and eliminated unnecessary financial costs.”

 


Metabolic Support Consult for ICU & Ventilator Patients

Adrienne Carey, PharmD, BCPS, Clinical Pharmacist / Data Mining Program Manager at Freeman

“We created a group of rules to alert our Metabolic Support Team to the fact that a patient in our ICU is on a ventilator and may need a metabolic support consult for enteral or parenteral nutrition management. A metabolic support consult can sometimes get overlooked in these patients since at the time of admission they do not have an immediate need for nutritional support and no order for such is entered by a physician, but these patients still need to be monitored closely as after a period of time on sedation, they will need nutritional support. Our Metabolic Support Team is alerted to about 30 patients per month with these rules.”

Real-time Antimicrobial Stewardship Improves Care at Intermountain Healthcare

Laurie Blankenship, PharmD, Pharmacy Director at Park City Hospital of Intermountain Healthcare, discusses the benefits of working with VigiLanz on a daily basis.

“I can remember five years ago, when we didn’t have VigiLanz or any kind of software for antimicrobial stewardship, and we didn’t have nearly as many good catches and we didn’t make nearly as many interventions,” says Blankenship.

Watch this short video to learn more about how Blankenship and her team are using VigiLanz to improve patient care.

 

Transcript:

I am the pharmacy director at Park City Hospital, which is one of the 23 hospitals at Intermountain Healthcare. It’s a community hospital, so it’s a little bit smaller. We only have 37 beds. Because of the size, I’m more of a working director. So I do a lot of clinical work. I do work with VigiLanz on a daily basis. I’m the co-chair of the Antimicrobial Stewardship Committee that we have at Park City Hospital.


I can remember five years ago when we didn’t have VigiLanz or any kind of software for antimicrobial stewardship and we didn’t have nearly as many good catches and we didn’t make nearly as many interventions.


VigiLanz helps keep us up to date on any cultures or results. So it’s the real time feature—so important because it gives us all that feedback right when it’s currently happening. Instead of looking through the medical chart and trying to find those blood cultures or the urine cultures, VigiLanz gives us that real time data. So it allows us to make more appropriate antibiotic choices, shortened duration of therapy, identify if there’s a bug drug mismatch and even identify discharged patients, which is a really big thing that we use it for. If the patient went home and their culture grew something that we need to change therapy, it’s a great tool for identifying those patients that are already out of our system.


My favorite part of working with VigiLanz is that we have all the information in one portal for antimicrobial stewardship. It includes our emergency room, it includes our ICU, it includes our med-surg, and all of it, again, is in real time. We have all that at our fingertips and an easily accessible tool to help us make the best decisions and to help us tailor and recommend, make awesome recommendations to physicians and to improve patient care. That’s the most important thing.

Top Five Tasks Infection Preventionists Need to Prioritize in 2020

The more you plan and prepare, the safer your patients will be. Here’s advice from our clinical team members. 

As the New Year begins, it’s critical for infection preventionists to begin thinking about—and preparing for—the year ahead. The more you can plan and prepare, the safer your patients will be. Here are the top five tasks (in no particular order) that our clinical team members say all infection preventionists need to prioritize over the next few months:

1.  Continue monitoring re-emerging diseases such as measles and mumps.

Recent outbreaks of measles have resulted in the largest number of confirmed measles cases the U.S. has seen in 25 years, according to the CDC. Mumps is also a problem, with 48 states reporting mumps infections in 2,618 people between January 1, 2019 and October 11, 2019.

Since screening for measles and other reemerging diseases often requires specialized testing, and there can be delays in receiving positive results from off-site labs, you must have a surveillance tool in place that can assist with identifying patients that may be symptomatic, rather than waiting on the final results. That way you can respond as quickly as possible.

At APIC 2019, Jennifer Boe, BSN, RN, PHN, CIC, an infection preventionist at Children’s Minnesota, shared how she and her colleagues used VigiLanz’s clinical surveillance technology to help quell a measles outbreak in their community in 2017. “We worked with our VigiLanz support team member to create a new rule, which alerted us whenever a measles test was ordered,” said Boe. “… Knowing about suspect cases ahead of time ensured we were in the loop, and it allowed us to identify potential exposures so we could rapidly respond if the measles test was positive.”

2.  Stay on top of emerging pathogens and outbreaks.

While it’s critical to monitor re-emerging diseases, it’s also important to watch for newly emerging problems. Another serious outbreak, such as Ebola, for example, could occur at any time here in the United States.

You must closely monitor your patient population for any problems and ensure you have tools in place that will flag potential problems in real time. Also, make sure you have a plan so that if a problem does arise, you can respond as quickly as possible (such as by isolating patients as soon as a test is ordered, rather than waiting for a positive result).

3.  Monitor the spread of MDROs, such as Candida auris, and heighten your prevention efforts.

In 2013, the CDC estimated that 23,000 people a year die as a result of antibiotic-resistant germs; it recently nearly doubled that figure to 44,000 deaths.

We don’t need to tell you what a serious problem MDROs represents, but we can’t stress enough how critical it is to closely monitor your patient population. You must ensure you have a flexible and robust surveillance tool that can assist in the identification of at-risk, exposed, and infected patients in real time. The faster you can respond to these issues, the safer your patients will be.

4.  Watch for NHSN changes impacting surveillance.

Every year, NHSN makes changes to its patient safety definitions. You can find a summary of the 2020 NHSN changes here. You must have a clinical surveillance platform that is ready to implement those changes at the start of 2020 so that the transition is seamless. At VigiLanz, we’re proud of our ability to quickly adapt and implement changes into our system based on new requirements and your healthcare system’s unique needs.

For example, at the very beginning of the New Year, we revised our CLABSI rules to account for the 12 organisms NHSN added as commensal organisms. We’re also ready to start allowing our users to report on HAI and LABID events via our file submissions. We will provide a more in-depth summary of the changes we’ve made to accommodate the 2020 updates from NHSN in our upcoming customer newsletter.

5.  Improve efficiency related to identifying, documenting, and preventing risks.

Identifying potential problems related to the care environment, equipment cleaning, and sterilization, requires frequent rounding and the ability to quickly compile and disseminate your findings to stakeholders who can remediate the problems. 

VigiLanz enables you to use real-time rounding tools to more efficiently document and monitor isolation compliance, hand hygiene, ICRAs, and EOCs. This ensures problems are addressed sooner, and it enables you to spend more time focusing on direct patient care.

If you already have VigiLanz in place, consider streamlining your rules so that only actionable items appear in the workflow (your clinical support team member would be happy to assist with this). Reducing the number of activations that are being created because they are nice to have, rather than needed, will reduce the time you spend working through lists.

To learn more about how to use VigiLanz to accomplish these tasks and ensure a safer 2020 for your patients, contact us today.