Antimicrobial Stewardship and Pharmacy

Antelope Valley and VigiLanz: Increasing Cost-Savings Enterprise Wide

Customer Profile

Antelope Valley Hospital (AVH), a 420-bed district hospital located in Lancaster, California, has been serving northern Los Angeles County for more than 60 years. The area’s only full-service acute-care hospital, AVH provides a full array of medical and surgical services, mental health services, cancer care, and more. It is a Level II trauma center, accredited chest pain center, advanced primary stroke center and comprehensive community cancer center.

Challenge

Hospitals and health systems across the country consistently seek methods to improve patient care and reduce costs due to an increased focus on value-based care and fee transparency. For Antelope Valley, that meant looking at the hospital’s pharmacy department and implementing a system that would go beyond cost savings and efficiency within this one department.

“There came a point when we were advancing services, staffing and activity that we were somewhat limited in what we could do, like running reports,” explained Jill Bennett, PharmD, BCPS, Clinical Coordinator, Antelope Valley Hospital. “[Our current system] really only enabled us to look at a certain subsection of our population and only provided a snapshot of activities throughout the day. It was limiting.”

Bennett and her staff needed to make a change to accurately capture their entire patient population and intervene as needed. The team moved through several different systems. While it was more than what most hospitals had at the time, AVH needed more. It required a solution that had a dedicated rules engine, 24-hour surveillance and the ability to grow beyond pharmacy. After researching multiple platforms, the decision was clear: It had to be VigiLanz.

VigiLanz empowered the team to automatically screen and monitor every patient, while streamlining dosing, testing and reporting—and appropriately intervene and adjust treatment per a patient’s tailored therapy.

Solution

Antelope Valley Hospital initially implemented VigiLanz to condense product line software in the hospital and assist with adverse drug reaction reporting (ADR) and medication safety monitoring, but Bennett and her staff saw the data-sharing potential in the VigiLanz solution.

Thanks to data-sharing through the VigiLanz platform, Antelope Valley is able to utilize the platform as the primary source for ADR information and data storage, helping to eliminate more manual processes.

“The Electronic Health Record (EHR) does provide alerts for us at the point of order verification, which is where the pharmacist is typically working, but we don’t always have the time to address all of those things…we [also] don’t get as many rules, or the complexity of the rules that we do with VigiLanz at the point of order verification.”
— Jill Bennett, PharmD, BCPS, Clinical Coordinator, Antelope Valley Hospital

As the use of VigiLanz in the pharmacy department expanded, Bennett and her staff prepared to pull in other departments. The goal from the onset was to use VigiLanz to help solve issues related to antimicrobial stewardship, formulary compliance, Centers for Medicare and Medicaid Services (CMS) quality indicators, National Healthcare Safety Network (NHSN) reporting, and direct budget initiatives. It was a tall order, but VigiLanz delivered on it all.

Today, Antelope Valley also uses VigiLanz to submit antimicrobial stewardship data via NHSN AUR (only the AU piece currently) and perform data abstraction and submission as part of the Public Hospital Redesign and Initiatives in Medi-Cal (PRIME) program in California. For the PRIME metrics, it assists Antelope Valley in the data abstraction for perioperative prophylactic antibiotics administered after surgical closure and captures a variation on the metrics of the National Quality Forum 2720: National Healthcare Safety Network Antimicrobial Use Measure, primarily focused on the MRSA drugs and antipseudomonal beta-lactams. This offers Antelope Valley the ability to track and assist in improving these metrics and provides an opportunity to recover funds.

The problem-solving doesn’t stop there. Bennett also works as a VigiLanz champion to engage other departments and show the solution’s ability to generate reports in a variety of settings.

“We wanted to pull dietary into the loop. Early on, I gave [the department] ways that they would be able to follow patients that were either on TPNs or warfarin. I’ve also reached out to respiratory services about monitoring isolation patients, respiratory orders or sputum cultures,” added Bennett. “Nursing has also used it, particularly related to patient education and anticoagulation and the tracking mechanism, so they have a report set up that they are using.”

Outcomes

With the help of VigiLanz, Antelope Valley staff can now create more accurate reports and utilize them more effectively, streamlining workflow and optimizing patient outcomes. VigiLanz’s ability to function at the enterprise level has allowed Antelope Valley to rededicate resources to other care improvement initiatives. It has also streamlined compliance with federal and state requirements, while generating financial rewards in the form of recovered funds from programs like PRIME that can be reinvested into the hospital.

Another core target for Antelope Valley was improvement related to antimicrobial stewardship. Its clinical pharmacists used VigiLanz to reduce illness by increasing the capture of grouped antimicrobial-related interventions, and their sum of cost savings went from $2.8 million in 2016 to more than $3.6 million in 2017. With intervention on the fired alerts and an increased focus on stewardship rounding, Antelope Valley has progressively eliminated inappropriate use and reduced its antimicrobial days of exposure per days present (risk for antimicrobial exposure per time unit of analysis stratified by location). A facility-wide analysis is also calculated and has improved.

Adverse event avoidance documentation capture in 2016 as a sum of cost savings totaled more than $576,232, and in 2017 it was $474,064, a rather significant contribution that is likely underestimated in terms of harm avoided and costs incurred. In the last two years, the Emergency Department alone documented more than $100,000 in savings.

Bennett acknowledges that there is still work to be done, but hopes exercises in cost-savings, interventions and reporting will show hospital leadership that the VigiLanz investment is—and will continue to be—an investment in themselves and the patients they serve.

“I’ve always said that pharmacy is the only department in the hospital that can actually save you money…the value derived from VigiLanz supports that.”
— Jill Bennett, PharmD, BCPS, Clinical Coordinator, Antelope Valley Hospital

RESULTS

Savings

Estimated savings

by activations acknowledged/month

2.8 million-2016 3.6 million-2017


Savings

Estimated savings

for antimicrobial stewardship

7.7 million-2015 11.2 million-2016 10.2 million-2017