Antimicrobial Stewardship And Pharmacy

Palomar Health Leverages VigiLanz to Enhance Rapid Diagnostics for Antibiotic Resistance

Back Story

A healthcare system with breadth and depth

Palomar Health is a comprehensive healthcare system providing a full spectrum of healthcare services to communities in an 850-square-mile region, and a trauma center that covers more than 2,200 square miles of South Riverside and North San Diego County, the largest hospital district in California. In addition to three state-of-the-art hospitals—the 288-bed Palomar Medical Center Escondido, 319-bed Palomar Medical Center Downtown Escondido and 107-bed Palomar Medical Center Poway—the health system offers home health care, surgery, skilled nursing, ambulatory care, behavioral health services, wound care, and community health education programs.

At the forefront of technology, Palomar Health leverages the latest in medical technology without losing sight of the personal side of healthcare. This approach is why Palomar Health is nationally recognized for providing the highest quality of clinical care and access to comprehensive services.

Challenge

Fighting antibiotic resistance with rapid diagnostics

Antibiotic resistance is growing rapidly, with the Centers for Disease Control and Prevention reporting that at least 2 million people are infected with antibiotic-resistant bacteria each year, 23,000 die as a direct result, and many more die from associated complications. For hospitals, combating these “nightmare bacteria” requires, among other things, rapid diagnosis and appropriate treatment, and closely monitoring resistance patterns within the facility.

heartAT LEAST 2 MILLION PEOPLE ARE INFECTED WITH ANTIBIOTIC-RESISTANT BACTERIA EACH YEAR. 23,000 DIE AS A DIRECT RESULT.
“With blood infections, time is life because if you’re not getting the right antibiotic, that bacterium will kill you. It will cause you to go from a regular medicine floor to the ICU, or to progress towards death,” said Mike Kruse, Palomar Health’s manager of Clinical Pharmacy Services. “Keep in mind that bacteria have growing resistance, so we need to know what it is because it’s not going to stay the same over time, nor is it going to be the same between one patient and another.”

But it’s not as simple as accelerating the process. The blood cultures required to identify the correct bacterium, and therefore treatment, typically take 2–3 days. Until then, clinicians can only make their best educated guess.

heartIDENTIFICATION TYPICALLY TAKES 2–3 DAYS. UNTIL THEN, CLINICIANS CAN ONLY MAKE THEIR BEST EDUCATED GUESS.

Determined to reduce the severity of antibiotic resistance, Palomar Health began using the VERIGENE® System to enable rapid diagnostics with the VERIGENE® Gram-Positive and Gram-Negative Blood Culture Tests. Performed directly on positive blood culture bottles, rapid diagnostics rely on simultaneous screening to quickly detect infectious pathogens and drug resistance markers. This speeds detection of certain bacteria that are responsible for some of the most challenging and deadly infectious diseases, such as methicillin-resistant Staphylococcus aureus (MRSA) and gram negative rods such as E. coli. “It’s not quite Star Trek medicine, but it’s exciting enough that you feel as though you’re seeing Star Trek beginning to happen,” said Kruse. “It’s nucleic acid testing and that means at the genetic level, we are looking for pieces of genes that actually tell us what that bacterium is. We are even looking for pieces of genes that tell us the code for antibiotic resistance.”

Like any new technology, though, clinician adoption is imperative to the success of rapid diagnostics. It’s not enough to push the information into the patient’s electronic medical record, or even to push an alert to the clinician at the point of care. It must also be acted upon quickly and appropriately.

“We’d not used rapid diagnostics yet, so you’re not going to have every single provider knowing what to do with the information, or they’re not seeing it fast enough. So, then, what’s the purpose of rapid if it’s not really making rapid decisions?” said Kruse. “That’s where VigiLanz comes in.”

SOLUTION

Pair VERIGENE® with VigiLanz

Palomar Health had implemented the VigiLanz clinical surveillance platform approximately two years prior to adding rapid diagnostics. At the time, they sought a solution that would provide “a daily list of tasks for our pharmacists, but also let them tap into clinical decision support so that we could improve the care for our patients and find things that we would not otherwise have found,” said Kruse. “After we’d had it in place for about two years, that’s when we began to use it to innovate.”

Rapid diagnostics is a prime example of the innovation made possible by VigiLanz. There are approximately 30 different iterations of bacteria or resistance patterns identifiable by VERIGENE®. So Palomar Health’s pharmacy team worked closely with the VigiLanz team to build approximately 60 rules to match bacteria with antibiotics, as well as mismatch rules.

heartRAPID DIAGNOSTICS IS A PRIME EXAMPLE OF THE INNOVATION MADE POSSIBLE BY VIGILANZ.

“In some cases, it’s just an optimization of therapy, for example an antibiotic might be covered but it’s the most expensive one, or it is one that will cause more side effects,” said Kruse. “But the ones we really worry about are complete non-coverage, where you have bacterium growing and the current antibiotics are not going to cover it at all. That’s what’s exciting when you tie together VERIGENE® and VigiLanz.”

Results

Though rapid diagnostics has not yet been part of the clinical workflow long enough to generate tangible metrics, Kruse says it looks promising.


VigiLanz bacteria identified

Instead of taking three days, bacteria are being identified in 12–24 hours. Pharmacists are acting on results in less than an hour of receipt.


pharmacists conversation with prescribing physician

Further, because pharmacists are trained to interpret potential drug-bug mismatches, they can have a conversation with the prescribing physician to help them learn how to use rapid diagnostics and help them interpret results faster.


Morbidity and Mortality Reduction Pager

“We’ve done that, but we’ve also gone one step further, which is that the VigiLanz system allows this to go to a pager, which I call the Morbidity and Mortality Reduction Pager. The complete drug-bug mismatches are the first ones sent, so our antimicrobial stewardship pharmacist receives a message on his phone,” said Kruse. “Within less than an hour of a result coming back now, we’re jumping on it.”


“With VERIGENE® providing rapid diagnosis, VigiLanz accelerating analysis and workflow, and the pharmacist providing faster quality improvement, “The result is that in the more than 900 patients with blood infections per year, we would save 82 lives that would not otherwise be saved.”

— Mike Kruse, Manager of Clinical Pharmacy Services