Antibiotic Stewardship in Action: Southwest Health System’s ApproachPosted on by
Penicillin discoverer Andrew Fleming warned in 1945 that overuse of the antibiotic could result in resistant bacteria. In 2017, we are facing that era for most antimicrobials. Medical professionals are working to slow the spread of antimicrobial resistance, and small hospitals can perform many of the same stewardship activities as larger facilities. While critical access hospitals (CAH) face unique stewardship challenges because of their often-limited resources, they can address antimicrobial use patient by patient.
In our CAH hospital, we have enjoyed active leadership support for our stewardship team of physicians, nurses, pharmacists, wound care, lab, and clinic providers. Using an affordable third-party vendor, we upload data to the NHSN AU module and analyze antimicrobial usage by provider. We share data at meetings at multiple levels and individually with providers, and we bring in local, regional, and national experts to speak about stewardship at our employee orientations and educational events.
Our pharmacy/infection prevention department leads the stewardship program, provides drug expertise, is the order gatekeeper, and provides audit and feedback at order review. In daily team rounds, we discuss and address changes to antibiotic therapy, antibiotic time out, dose de-escalation, and days of therapy. We compile lab data into a yearly antibiogram.
Since hospital efforts alone will not keep us from losing antimicrobial efficacy, our goal is community stewardship. We are working with a local 500-bed long-term care system to reduce antibiotic use for UTI and with Colorado Hospital Association’s statewide stewardship efforts in reducing antibiotic use for SSTI and UTI. We have provided stewardship guidance for local dentists, and launched a UTI and URI stewardship plan in our eight clinics.
Either alone or through collaborative efforts, all critical access hospitals can apply the CDC Core Elements of Antibiotic Stewardship and implement a program that serves their hospital, clinics, and communities. As we face the threat of a post-antibiotic era, we have no choice.
Marc Meyer has been a clinical pharmacist for the past 27 years for Southwest Health System, a 25-bed critical access hospital with eight clinics in Cortez, Colorado. For the past 17 years, he has served as an infection preventionist and the system’s Director of Infection Control. He is a member of SHEA and SIDP, an APIC member and Fellow, and is board certified in infection control and epidemiology. He is also a member of the Colorado Hospital Association’s antimicrobial stewardship collaborative, where he works on statewide hospital stewardship projects. He designed a UTI stewardship project in a long-term care chain of 500 beds in seven facilities, with Phase One ending in April 2017. He was a listed author on NQF’s Antibiotic Stewardship in Acute Care: A Practical Playbook, released in 2016. He also works with the Pew Charitable Trusts and CDC on hospital antimicrobial stewardship projects and co-authored a review paper about small hospital stewardship published in the journal CID in May 2017.