Freeman Health System, a 485-bed, three-hospital system in Joplin, Missouri, serves an area of 450,000 people across Missouri, Arkansas, Kansas, and Oklahoma. It is the #1 hospital in Southwest Missouri and the #4 hospital in Missouri, according to U.S. News & World Report.
Hospitals across the country are fighting to combat antibiotic overuse, resistance, and unwanted side effects, but many are struggling to implement new and effective workflows that help meet these goals. Much of the challenge boils down to speed and efficiency—hospitals need to identify antibiotic overuse more quickly, and intervene sooner when it does occur.
Freeman Health System is no exception to the challenges associated with antimicrobial stewardship (ASP), and it was looking for a way to improve its ASP processes, particularly related to vancomycin use among patients with pneumonia.
“Data shows that 98 percent of the time, a negative MRSA screen for a patient with pneumonia means that a patient does not have MRSA-pneumonia, and their empiric vancomycin therapy can safely be discontinued,” said Adrienne Carey, PharmD, BCPS, Clinical Pharmacist and Data Mining Program Manager at Freeman Health System. “We wanted to streamline our MRSA screening process so that we could more quickly identify if a MRSA screen is negative, and therefore, discontinue vancomycin use sooner.”
Freeman Health System’s antibiotic stewardship team had already changed the health system’s pneumonia pathway orders to ensure all patients who came into the ER automatically received a nasal screen for MRSA.
“Our pharmacy department was tasked with educating physicians about the change and with contacting them with the results,” said Carey. “The goal was to de-escalate patients’ antibiotics more quickly.”
The problem was that results were not always communicated quickly to pharmacists, so there was sometimes a delay in identifying patients whose vancomycin therapy could be discontinued.
Freeman Health System turned to VigiLanz to help, working with the VigiLanz clinical support team to create a negative MRSA screen rule within the system. Now, whenever a patient prescribed vancomycin has a negative MRSA screen and no other cultures are positive for MRSA, the pharmacy team and infectious disease physician receive an alert in real time.
“Before implementing the VigiLanz rule, we had to manually run reports through our health information system to view all patients on vancomycin, then check each patient’s microbiology results to see if they had been screened for MRSA,” said Carey. “That took a lot of time.”
Now, pharmacists and physicians can more quickly discontinue vancomycin use and switch to an alternate antibiotic when appropriate, she explained. “We are not leaving our patients on vancomycin any longer than necessary.”
Adrienne Carey, PharmD, BCPS describes real-time alerts helping pharmacists
In the first six months since November 2018, when the new workflow was implemented, Freeman Health System’s pharmacists worked with physicians to discontinue vancomycin therapy in 70 patients.
Other key benefits of the new approach include:
- Time savings for pharmacists
- Time savings for nurses by reducing doses and drawing fewer labs
- Monetary savings by reducing unneeded antibiotics
- Reduced risk of infection through an IV route since IV lines are discontinued sooner due to de-escalation
- Fewer medication side effects
- Less chance for antibiotic resistance
- Improved patient satisfaction due to fewer medications being administered
- Shorter lengths of stay
“Building this rule and receiving immediate alerts from VigiLanz is helping us better identify all patients who qualify to have their therapy de-escalated and do so in a timely fashion,” said Carey. “We have also seen a trend toward less vancomycin usage overall.”