scholarly journals 133. A Review of Antimicrobial Formularies at Rural Hospitals: Stewardship Opportunities Abound

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S179-S179
Author(s):  
Peter Bulger ◽  
Alyssa Y Castillo ◽  
John B Lynch ◽  
John B Lynch ◽  
Paul Pottinger ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Care ◽  
Rural Hospitals ◽  
Critical Access Hospitals ◽  
University Of Washington ◽  
Suitable Alternative ◽  
Hospital Size ◽  
Stewardship Program ◽  
Intravenous Acyclovir ◽  
The University

Abstract Background Management of a hospital’s antimicrobial formulary is an important aspect of antimicrobial stewardship and cost containment strategies. Ensuring that essential medications for clinical care are available and excluding therapeutic duplicates and unnecessary antimicrobials is time and resource intensive. Comparisons of antimicrobial formularies across multiple rural hospitals have not been evaluated in the literature. We hypothesized that a comprehensive formulary evaluation would reveal important opportunities for antimicrobial stewardship efforts and could help smaller hospitals optimize available medications. Methods The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) is comprised of 68 hospitals of varying sizes, most of which are rural and critical access, in Washington, Oregon, Arizona, Idaho, and Utah. We surveyed UW-TASP participating hospitals and other networked rural hospitals in multiple Western states using REDCap, a HIPAA-compliant, electronic data management program. Respondents reported which antimicrobials are on their hospital formulary as well as basic information about hospital size and inpatient units. Data were reviewed by a panel of infectious diseases trained physicians and pharmacists at UW-TASP. Results Surveys from 49 hospitals were received; two were excluded from the data analysis (Table 1) – one submission was incomplete, and one was a large inpatient psychiatric hospital. Select antimicrobials and proportion of hospitals carrying these agents is shown in Table 2. Several antimicrobials are on the formulary at all hospitals, regardless of size. In some critical access hospitals (< 25 beds), empiric first-line bacterial meningitis and viral encephalitis coverage (Table 3) was lacking. Six hospitals (12.7%) lacked ampicillin for Listeria coverage and only one had a suitable alternative agent (meropenem). Seven hospitals (14.9%) lacked intravenous acyclovir, although three had oral valacyclovir. Formulary inclusion of agents for multi-drug resistant organisms was rare. Conclusion In critical access hospitals in the Western USA, lack of essential empiric antimicrobials may be more of a concern than inclusion of agents with unnecessarily broad spectra. Disclosures Chloe Bryson-Cahn, MD, Alaska Airlines (Other Financial or Material Support, Co-Medical Director, position is through the University of Washington)

scholarly journals 2091. Use of Telehealth to Expand Antimicrobial Stewardship Capacity Among Critical Access Hospitals in Washington State

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S706-S707
Author(s):  
Staci Kvak ◽  
Chloe Bryson-Cahn ◽  
Marisa A D’Angeli ◽  
Zahra Kassamali ◽  
Rupali Jain ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
The United States ◽  
Successful Implementation ◽  
Critical Access Hospitals ◽  
Conference Calls ◽  
University Of Washington ◽  
Resource Limited ◽  
Stewardship Program ◽  
Core Elements ◽  
The University

Abstract Background Critical access hospitals (CAH), defined as those with 25 or fewer beds and/or located in rural settings, may have difficulty implementing core elements of antimicrobial stewardship (CES) due to limited human resources, expertise, and funding. A 2015 National Healthcare Safety Network (NHSN) hospital survey found only 26% of CAH reported implementing all 7 CES compared with 50% of larger hospitals across the United States. The University of Washington Tele-Antimicrobial Stewardship Program (UW TASP) was developed through partnership with the University of Washington for hospitals lacking stewardship resources. The state department of health (DOH) provided funding to allow CAH to participate. Methods In January 2017, CAH were recruited to join UW TASP and participate in weekly 60 minute audiovisual conference calls led by an interdisciplinary team of infectious diseases physicians, pharmacists and microbiologists. Each session included a 15-minute didactic on stewardship topics followed by a discussion of case studies presented by participating hospitals. UW TASP faculty visited CAH to foster a collegial relationship between teams. Using hospital-reported metrics from the NHSN hospital survey reported in year 2016–2018 for years 2015–2017, we compared CES implementation by CAH participating in UW TASP (TASP CAH) in 2017 (n = 17) to those not participating (non-TASP CAH) (n = 22). Results TASP CAH reported increased implementation of all 7 CES from 29% (2015) to 59% (2016) before joining TASP to 76% (2017) after joining TASP (Figure 1). Non-TASP CAH reported implementation increased from 32% (2015) to 45% (2016) to 59% (2017). By the end of 2017, TASP CAH also succeeded in implementing individual CES to a greater degree than did non-TASP CAH (Table 1). Conclusion TASP CAH reported more successful implementation of CES than did non-TASP CAH. Improved CES implementation in TASP CAH may in part be due to differences in baseline hospital characteristics; however, expertise and support provided by UW TASP likely contributed. The use of telehealth mentoring increased antimicrobial stewardship in this resource-limited setting. Disclosures All authors: No reported disclosures.

scholarly journals 860. HIV Post-exposure Prophylaxis Availability at Small and Critical Access Hospitals in the Western Region

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Alyssa Y Castillo ◽  
Peter Bulger ◽  
John B Lynch ◽  
John B Lynch ◽  
Paul Pottinger ◽  
...  
Keyword(s):  
Rural Areas ◽  
Post Exposure Prophylaxis ◽  
University Of Washington ◽  
Convenience Sample ◽  
Hospital Formulary ◽  
Hospital Size ◽  
Post Exposure ◽  
Stewardship Program ◽  
Exposure Prophylaxis ◽  
The University

Abstract Background Post-exposure prophylaxis (PEP) is essential to minimize the risk of human immunodeficiency virus (HIV) acquisition following an occupational or nonoccupational exposure to potentially infectious body fluids. PEP is most effective when initiated as soon as possible after HIV exposure. Patients in rural areas may rely on small (< 50 beds) and critical access (< 25 beds) hospitals for access to PEP – especially after-hours and on holidays, when outpatient pharmacies are typically closed. However, PEP medications are costly to maintain on a hospital formulary due to unpredictable use and expiration. We hypothesized that PEP availability may be variable and limited at such hospitals. Methods The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) is comprised of 68 hospitals in Washington, Oregon, Arizona, Idaho, and Utah, most of which are rural and critical access. In August 2020, we surveyed UW-TASP participating hospitals and a convenience sample of other networked rural hospitals in Western states using REDCap, a HIPAA-compliant, electronic data management program. Respondents reported all antimicrobials on their hospital formulary and their hospital size. Data were reviewed by physicians and pharmacists trained in infectious diseases. Preferred PEP regimens, defined by the CDC, for adults and adolescents ≥ 13 years, included combination tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) and either raltegravir (RAL) or dolutegravir (DTG). Results Responses from 49 hospitals were received. Six were excluded – one was incomplete and five were excluded due to hospital size ( > 50 beds) (Table 1). The majority of hospitals (40/43, 93.0%) were critical access. Half of the hospitals’ formularies (22/43, 51.2%) contained a preferred PEP regimen. One hospital reported a non-preferred regimen. Most hospitals with a preferred PEP regimen on formulary (18/22, 86.3%) offered TDF/FTC + RAL, and the remainder (4/22, 18.2%) offered TDF/FTC + DTG. Conclusion Many small and critical access hospital formularies do not include antiretroviral agents needed for HIV PEP. Improving urgent access to these critical medications in rural communities is an opportunity for HIV prevention. Disclosures Jehan Budak, MD, Nothing to disclose Chloe Bryson-Cahn, MD, Alaska Airlines (Other Financial or Material Support, Co-Medical Director, position is through the University of Washington)

Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

2021 ◽  
pp. 1-3
Author(s):  
Joanne Huang ◽  
Zahra Kassamali Escobar ◽  
Todd S. Bouchard ◽  
Jose Mari G. Lansang ◽  
Rupali Jain ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Emergency Departments ◽  
Urgent Care ◽  
Complex Data ◽  
University Of Washington ◽  
Primary Care Clinics ◽  
Urgent Care Centers ◽  
The University

Abstract The MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.

scholarly journals Implementation of Rapid Molecular Diagnostic Tests and Antimicrobial Stewardship Involvement in Acute-Care Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s278-s279
Author(s):  
Maiko Kondo ◽  
Matthew Simon ◽  
Esther Babady ◽  
Angela Loo ◽  
David Calfee
Keyword(s):  
Antimicrobial Stewardship ◽  
Diagnostic Tests ◽  
New Technology ◽  
Clinical Care ◽  
Bloodstream Infections ◽  
Clinical Decision ◽  
Research Network ◽  
Molecular Diagnostic ◽  
Financial Outcomes ◽  
Stewardship Program

Background: In recent years, several rapid molecular diagnostic tests (RMDTs) for infectious diseases diagnostics, such as bloodstream infections (BSIs), have become available for clinical use. The extent to which RMDTs have been adopted and how the results of these tests have been incorporated into clinical care are currently unknown. Methods: We surveyed members of the Society for Healthcare Epidemiology of America Research Network to characterize utilization of RMDT in hospitals and antimicrobial stewardship program (ASP) involvement in result communication and interpretation. The survey was administered using Qualtrics software, and data were analyzed using Stata and Excel software. Results: Overall, 57 responses were received (response rate, 59%), and 72% were from academic hospitals; 50 hospitals (88%) used at least 1 RMDT for BSI (Fig. 1). The factors most commonly reported to have been important in the decision to adopt RMDT were improvements in antimicrobial usage (82%), clinical outcomes (74%), and laboratory efficiency (52%). Among 7 hospitals that did not use RMDT for BSI, the most common reason was cost of new technology. In 50 hospitals with RMDT for BSI, 54% provided written guidelines for optimization or de-escalation of antimicrobials based upon RMDT results. In 40 hospitals (80%), microbiology laboratories directly notified a healthcare worker of the RMDT results: 70% provided results to a physician, nurse practitioner, or physician assistant; 48% to the ASP team; and 33% to a nurse. Furthermore, 11 hospitals (22%) had neither guidelines nor ASP intervention. In addition, 24 hospitals (48%) reported performing postimplementation evaluation of RMDT impact. Reported findings included reduction in time to antibiotic de-escalation (75%), reduction in length of stay (25%), improved laboratory efficiency (20%), and reduction in mortality and overall costs (12%). Among the 47 hospitals with both RMDT and ASP, 79% reported that the ASP team routinely reviewed blood culture RMDT results, and 53.2% used clinical decision support software to do so. Finally, 53 hospitals (93%) used 1 or more RMDT for non–bloodstream infections (Fig. 1). Fewer than half of hospitals provided written guidelines to assist clinicians in interpreting these RMDT results. Conclusions: RMDTs have been widely adopted by participating hospitals and are associated with positive self-reported clinical, logistic, and financial outcomes. However, nearly 1 in 4 hospitals did not have guidelines or ASP interventions to assist clinicians with optimization of antimicrobial prescribing based on RMDT results for BSI. Also, most hospitals did not have guidelines for RMDT results for non-BSI. These findings suggest that opportunities exist to further enhance the potential benefits of RMDT.Funding: NoneDisclosures: None

scholarly journals Implementation of a Health-System Wide Antimicrobial Stewardship Program in Omaha, NE

Pharmacy ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 156
Author(s):  
Jennifer Anthone ◽  
Dayla Boldt ◽  
Bryan Alexander ◽  
Cassara Carroll ◽  
Sumaya Ased ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Health System ◽  
Antimicrobial Stewardship ◽  
Program Effectiveness ◽  
Medical Center ◽  
Academic Medical Center ◽  
Full Time ◽  
Critical Access Hospitals ◽  
Full Time Equivalent ◽  
Stewardship Program

The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial stewardship (AMS) program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.

1523: How We Learn Resection Skills: Analysis of Data from the University of Washington Turp Simulator

2004 ◽  
Vol 171 (4S) ◽  
pp. 401-401
Author(s):  
Robert M. Sweet ◽  
Timothy Kowalewski ◽  
Peter Oppenheimer ◽  
Jeffrey Berkley ◽  
Suzanne Weghorst ◽  
...  
Keyword(s):  
University Of Washington ◽  
The University

Combining the Love of Art, Science, Business and Medicine to Innovate and Enhance Patient Health. Highlights from the 7th Annual Leaders in Medicine Symposium of the Cummings School of Medicine, Calgary, AB

2018 ◽  
pp. E51-E54
Author(s):  
Jennifer Beatty ◽  
Michael Peplowski ◽  
Noreen Singh ◽  
Craig Beers ◽  
Evan M Beck ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Clinical Care ◽  
Clinical Problem ◽  
Faculty Members ◽  
Guest Speaker ◽  
School Of Medicine ◽  
University Of Calgary ◽  
Patient Health ◽  
The University ◽  
Care Costs

The Leader in Medicine (LIM) Program of the Cumming School of Medicine, University of Calgary, hosted its 7th Annual LIM Research Symposium on October 30, 2015 and participation grew once again, with a total of six oral and 99 posters presentations! Over 45 of our Faculty members also participated in the symposium. This year’s LIM Symposium theme was “Innovations in Medicine” and the invited guest speaker was our own Dr. Breanne Everett (MD/MBA). She completed her residency in plastic surgery at University of Calgary and holds both a medical degree and an MBA from the University of Calgary. In her inspiring talk, entitled “Marrying Business and Medicine: Toe-ing a Fine Line”, she described how she dealt with a clinical problem (diabetic foot ulcers), came up with an innovation that optimized patient care, started her own company and delivered her product to market to enhance the health of the community. She clearly illustrated how to complete the full circle, from identifying a clinical problem to developing and providing a solution that both enhances clinical care and patient health as well as reduces health care costs and hospital admissions. The research symposium was an outstanding success and the abstracts are included in companion article in CIM.

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