Tag: AntimicrobialStewardship

Customer Profile

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.

Challenge

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.”

Solution

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

Outcomes 

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.”

Related Resource:

• Efficiency improvements at Freeman Health System

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.

Customer Profile

Adventist Health and Rideout, a nonprofit community-based health system in Marysville, California, provides services across the full spectrum of care, including general medical/surgery, intensive care, and cancer care. Comprised of an acute-care hospital and numerous medical centers, it is known for high quality and high patient satisfaction.

Challenge

Hospitals across the country are experiencing high rates of hospital-acquired infections (HAIs). In fact, more than 800 health systems incurred reimbursement penalties from Medicare in 2019 because of too many HAIs, and one out of every 25 patients develops an infection while in hospitals, according to The Leapfrog Group.

Over the past few years, Adventist Health and Rideout has made reducing HAIs, particularly C. diff, a top priority. As a key part of this initiative, it has focused on reducing overprescribing of antibiotics, which is a common problem in hospitals, and which contributes to the rise in infections.

“We were struggling with overprescribing, with rates that exceeded the national average for similar hospitals of similar sizes,” explained Bryce Whitesides, PharmD, Pharmacy Operations Manager at Adventist Health and Rideout. “We were determined to improve our performance. We knew if we could improve, we’d see fewer infections.”

Solution

Before embarking on its initiative to curb HAIs, Adventist Health and Rideout was already using basic functions of VigiLanz’s platform to monitor patient care and fill in their EMR’s quality and reporting gaps. Still, Brock Taylor, PharmD, Clinical Manager at Adventist Health and Rideout, suspected the technology platform was underutilized.

“I spoke to our VigiLanz clinical support member who explained how we could use the technology to create more targeted and customized rules that would trigger alerts related to different types of data, such as prescribing data or lab data,” said Taylor. “The pharmacy team and infection prevention team then identified rules that we thought would be most helpful in monitoring and curbing infections.”

Now, pharmacists and physicians receive real-time alerts and if a red flag arises related to antibiotic prescribing—for example, if there is a mismatch between the medication ordered and the patient’s condition—pharmacists reach out to prescribing physicians to discuss the medication and determine if alternative approaches should be considered.

To further ensure appropriate antibiotic use, Adventist Health and Rideout’s infectious disease specialist and pharmacy clinical manager receive alerts if physicians prescribe an antibiotic that has restricted indications, such as ceftazidime/avibactam. Again, when this occurs, they work with prescribing physicians to ensure the prescription is appropriate.

“We developed these rules strategically so that pharmacists could provide clinical interventions more quickly if necessary,” explained Whitesides. “We’re making sure that we don’t contribute to the rise in infections in hospitals or in the community after patients are discharged.”

Adventist Health and Rideout also uses VigiLanz to help pharmacists and infection prevention team members determine if an infected patient acquired their infection in the hospital or in the community prior to or after the hospital visit. That’s because VigiLanz sends alerts as soon as lab data indicates a patient has an infection, such as C. diff. Since pharmacists and infection prevention team members are notified so quickly, it’s easier for them to determine the origin of the infection.

As the hospital has become better at identifying the origin, pharmacists and infectious disease team members have found that many of the infections they would have traditionally reported as HAIs actually originated in the community, said Whitesides. As a result, the hospital has improved its quality metrics related to HAIs.

“Before it was difficult to know if a C. diff infection was hospital or community acquired,” he said. “Now, we can show how our antibiotic optimization is working, and demonstrate that we’re helping to lower the community-acquired C. diff rates. We’re not sending patients home with unnecessary or prolonged antibiotic prescriptions.”

Outcomes

The continued focus on appropriate use of antibiotics, and on the de-escalation of antibiotic use when appropriate, has improved patient care at Adventist Health and Rideout. It has also led to significant cost savings.

C. diff. infections have fallen from several monthly to approximately one every other month, and use of Zosyn and other broad-spectrum antibiotics has declined significantly, said Whitesides.

The the hospital is now meeting national standards for antibiotic utilization, and annual antibiotic usage expenditures have fallen $500,000 per year.

Recently, Adventist Health West System, a large integrated health system which owns Adventist Health and Rideout, decided to replicate Adventist Health and Rideout’s more optimized use of VigiLanz throughout all of its hospitals. Now, there are more than 20 medical centers on the West Coast and Hawaii using VigiLanz to support their efforts to curb HAIs and optimize antibiotic use.

“VigiLanz is a very powerful tool that we’ve used to make very significant interventions, not only in our patients lives but the hospital at large,” said Whitesides. “The impact continues to grow.”

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