Antimicrobial Stewardship

Riverside University Health System Uses VigiLanz for NICU Antimicrobial Stewardship

Customer Profile 

Riverside University Health System Medical Center (RUHS), a 439-bed facility in Moreno Valley, California, is committed to delivering exceptional care—and its quality performance reflects that commitment. Recognized by The Joint Commission as a top performer on key quality measures, RUHS has received awards from the American Heart Association/American Stroke Association. It is also recognized as a Baby Friendly Hospital by the World Health Organization and the United Nations Children’s Fund.

Challenge

As part of its commitment to providing optimal patient care, RUHS participates in the California Perinatal Quality Care Collaborative, a statewide network of California’s neonatal intensive care units (NICUs) and high risk infant follow-up clinics. In 2016, the collaborative launched an antibiotic stewardship (ASP) initiative with 28 NICUs, including RUHS.

At that time, RUHS had an antimicrobial stewardship program (ASP) for all patients, but it did not have a program that was focused solely on pediatric and NICU patients. “As we looked more closely at the younger patient population, we realized there was room for improvement in this area,” said Nikita Patel, Assistant Director of Pharmacy–Clinical Programs & Quality Improvement at RUHS.

She noted that, while there are established clinical practice guidelines for neonatal early onset sepsis management, they can contribute to higher antibiotic use—sometimes unnecessarily.

“If a baby has an active infection the first two to three days of life, the mortality outcomes are staggering and antibiotic use can be life-saving,” said Patel. “But unnecessary antibiotic use can disrupt a baby’s gut microbiome and impact their long-term immune response. This puts them at a higher risk of developing chronic diseases like asthma, and can lead to antibiotic resistance.”

Solution

RUHS turned to VigiLanz to support its efforts to optimize antibiotic use among pediatric and NICU patients. The clinical surveillance solution—which continuously gathers information from the medical center’s EMR and other sources, analyzes that data in real time, and provides meaningful insights to healthcare providers—enables pharmacists to view robust antimicrobial utilization reports. “The reports help us continuously monitor antimicrobial use and assess prescribing trends,” said Patel.

VigiLanz also provides relevant healthcare providers with real-time alerts that promote ASP in the NICU. These alerts include:

  • 48-hour antibiotic timeouts that enable NICU pharmacists to review information and recent lab results on relevant patients.
  • Positive lab results, so that pharmacists more quickly review critical labs and make appropriate medication change recommendations or antibiotic de-escalation.
  • Pharmacokinetic monitoring alerts, so that pharmacists can immediately make recommendations regarding dosage changes.
“I can’t emphasize enough how valuable VigiLanz is for us. It helps drive timely and important patient care interventions and improves our efficiency and documentation.” – Nikita Patel, Assistant Director of Pharmacy – Clinical Programs & Quality Improvement, RUHS

Outcomes

The new approach to ASP at RUHS has had a significant positive effect on patient care, said Patel. “I can’t emphasize enough how valuable VigiLanz is for us,” she said. “It helps drive timely and important patient care interventions and improves our efficiency and documentation.”

Two noteworthy outcomes of the new approach include:

  • A 37% decrease in NICU antibiotic utilization between March 2017 and March 2018. Importantly, that 37% drop has also been sustained since 2018.
  • More than 90% compliance with 48-hour antibiotic timeouts for all patients admitted to the NICU and initiated on antimicrobials.

VigiLanz also saves pharmacists time, which also benefits patient care, said Patel. “We no longer have to manually review patient lists and data every day,” she explained. “VigiLanz automatically sorts relevant data for us and alerts us when there’s a potential problem or when there’s something new to review. That helps us intervene more quickly and spend more time on other patient care improvement initiatives.”

 

To learn more about how VigiLanz helps hospitals improve their patient safety and clinical surveillance, visit https://vigilanzcorp.com/ today.

Results

RUHS’ use of VigiLanz for ASP in the NICU has led to significant care improvements that include:

  • A 37% decrease in NICU antibiotic use between March 2017 and March 2018. That 37% decrease has been sustained since 2018.
  • More than 90% compliance with 48-hour antibiotic timeouts for all patients admitted to the NICU and initiated on antimicrobials.

The Wide-Ranging Benefits of VigiLanz

In addition to supporting its ASP program Riverside University Health System Medical Center is using VigiLanz to enhance its:

  • Diabetes care management: The health system worked with VigiLanz to develop customized rules and reports that enable the diabetes care management team to closely monitor inpatient insulin usage to identify improvement opportunities and monitor care.
  • Critical meds oversight: The health system created a critical medication list in VigiLanz to ensure they always have sufficient critical medications on hand. The pharmacy procurement team receives alerts as soon as patients requiring critical medications are admitted, or a new critical medication is started. They can then immediately review the medication supply, and ensure sufficient stock for the patient’s stay. This is also beneficial for ensuring enough of the critical medication is on hand during weekends and holidays, when low inventory is particularly problematic.

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