My Journey to Antibiotic Stewardship (in a small, rural hospital)

Guest Author: Michael Stearns, RPh, CASAC, Director of Pharmacy, Ellenville Regional Hospital, Ellenville, New York

My interest in microorganisms and infection control – specifically as it relates to antibiotics – dates back to when I was in pharmacy college in the 1970s. I worked in a microbiology laboratory, which I found fascinating. Fast forward to the early 2000s, there was now a name for the consultations and interventions I had provided as a pharmacist – “Antimicrobial Stewardship.”

In recent years, our small rural hospital, Ellenville Regional, participated in the Health Resources & Services Administration (HRSA) Patient Safety and Clinical Pharmacy Services program, which highlighted the need for effective patient-provider liaisons and improved communication and better management of antibiotic prescriptions – both inside the hospital and within the community.

Working with that program, our hospital made significant clinical improvements, including:

• More than 80% of patients who were prescribed intravenous (IV) antibiotics received them in less than 30 minutes.
• More than 90% of patients with IV antibiotics converted to oral antibiotics post-pharmacy consultation.
• Pharmacists reviewed more than 90% of Culture & Sensitivity Reports; Infection Control Nurses reviewed 100% of these reports.
• With provider consultation, pharmacists performed antibiotic dose adjustment evaluations in more than 90% of patients.

These clinical improvements reduced Ellenville’s antibiotic-related expenses by 26% in 2016 versus 2015.

Here are a few best practices and pointers I can share based on my experience with implementing an antibiotic stewardship program in a small, rural hospital:

• Use the CDC Core Elements as a framework
• Take a multidisciplinary approach – involve physicians, pharmacists, infection control nurses and administrative staff
• Timely, effective communication is a must
• Measure your results and get feedback from your team
• Educate your team and get their buy in

Creating and defining the characteristics of antibiotic stewardship programs was critical to our success, as was attending the CDC & Pew Charitable Trusts Small and Critical Access Hospitals ASP Convening. This event took place in Atlanta in April 2017 and brought together other stakeholders to network, share ideas and discuss achievements and challenges related to antibiotic stewardship programs.

I had to bolster my knowledge and confidence along the way; however, Ellenville Regional’s progress in the antibiotic stewardship sphere has proven well worth the effort.

Implementing a cohesive, successful antibiotic stewardship program has empowered our team to create a safer, more efficacious patient experience within our facility and in the community.

Michael Stearns, RPh, CASAC is the Director of Pharmacy for Ellenville Regional Hospital and has been in this role since 2003. He was previously employed by Ellenville Community Hospital, where he was the Coordinator of Chemical Dependency Services and the Hospital Planner. Stearns graduated from Albany College of Pharmacy in 1978 and his healthcare career spans over 40 years. As an Adjunct Experiential Faculty member for Albany College of Pharmacy, Stearns precepts pharmacy students from Albany College of Pharmacy, Long Island University and Rhode Island University. Stearns is also a New York State Credentialed Alcoholism and Substance Abuse Counselor (CASAC) and is active in the community. He has previously served on the Ellenville Village Board and the Hospital Board.

For more information about Ellenville Regional Hospital.