Antibiotic Stewardship Program In West Texas VA Outpatient Clinics

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Antibiotic Stewardship Program In West Texas VA
Outpatient Clinics

• By
• Elizabeth Moos, RN
• Dawn McCright, MT(ASCP)

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Proposal

• Improve Availability of Antimicrobial Data
• Electronic Antibiogram
• Establish Specific Treatment Modalities
• Electronic Order Sets
• Compare Past Treatment Practice with New
• Oct 07 - Mar 08 vs. Oct 08 - Mar 09
• Evaluate and Measure Outcome
• Antibiotic Use (costs)
• MRSA and Clostridium difficile rate
• Patient Return Hospitalization

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Rational

• Mitigate Emerging Infections and Resistance
• Reduce Return Clinic Visits Hospitalization
• Reduce Pharmaceutical Costs
• Standardize Treatment
• Enhance Veteran Care

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Measure

• Initial Look Back of Prior Treatment Practice
• Baseline
• Compare Initial Look Back with Outcome
• Oct 07 - Mar 08 vs. Oct 08 - Mar 09
• MRSA and C. difficile rate
• Costs

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Initial Findings

• October 2007 through May 2008 (BASELINE)
• Inconsistency with Treatment Practices
• Empiric use of Antibiotic
• Suspected Cost Increase
• Suspected Increase in Antimicrobial Resistance

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Respiratory
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Wounds
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UTI
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Other Eye, Ear, GI, etc.
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Not Indicated
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Steps In Development of Order Sets

• Locate Infectious Disease Physician
• Presentation to Providers
• Form Taskforce to Develop Order Sets
• Obtain Order Set Examples for Use by IT
• Test Order Sets
• Train Providers in Order Set Use
• Implement in Clinics

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Challenges

• Timeliness of Forming Team
• Insufficient Data Collection Support
• Timeliness of Infectious Disease Support
• Timeliness of Development of Treatment Modalities
• Patient Education

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Expected Outcomes

• Decrease Treatment Cost
• Enhanced Education of Staff Public
• Enhanced Treatment Intervention
• Standardized Treatments
• Eventual Decrease or Leveling of Emerging
  Resistant Organisms
• Enhanced Veteran Care

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Future Plans

• Expand to ALL WTVAHCS Clinics
• Partner with Other Facilities
• Involve Community Hospitals
• Develop Integrated Sharing of Information
• Increase Patient Awareness

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Questions