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12 Cards in this Set
- Front
- Back
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Reasons for Antimicrobial Stewardship necessity |
1. Alarming rates of antimicobial use 2. Decrease mortality due to consequences of resistance 3. Decreases C. dificile cases 3. Leads to higher cure rates 4. Need to reserve efficacious drugs sue to lack of new drug development 5. Regulatory compliance 6. cost savings |
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Consequences of drug resistance |
1. Increased mortality due to decreased drug efficacy and available treatment options 2. Need to withhold treatments that require immunocomprising the patient (e.g. Chemotherapy) 3. Increase in C. dificile infections, and mortality, both as a primary and secondary diagnosis |
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The two professionals that lead Stewardship programs |
Clinical RPH with ID training ID Physician |
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6 Key players in Stewardship programs |
Clinical RPH with ID training Clinical microbiologist ID Physician Infection control specialist Hospital epidemiologist IT department representative |
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6 Stages of patient care where Stewardship is applied |
1. Diagnosis 2. Empiric treatment 3. Diagnostics/work-up 4. Re-evalution of patient 5. IV to po conversion 6. Determining duration of antimicrobial treament |
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7 components of Antimicrobial Stewardship |
1. Leadership committment 2. Antimicrobial formulary restriction 3. Antibiotic-use guidelines 4. Prospective audith and feedback 5. RPH driven drug use 6. Tracking days of Tx, cost per discharge 7. Education of pts, providers, RPHs |
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Steps in creating instition specific antimicrobial guidelines |
1. Creating a collaborative group 2. Development of guidlines using guidelines and hospital antibiogram 3. Implementation: computerized order entry, intranet algorithm access, staff education 4. follow-up |
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Stepwise Stewardship approach |
1. Is the pt infected? 2. Healthcare related risk factors? 3. suspected site/source of infection? 4. What pathogens are associated with this site? 5. What antimicrobials provide adequate coverage? 6. What pt/disease specific factors affect choice? 7. Empiric recommendation 8. Reassess/Monitor- De-escalate |
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Daily reassessment: The 5 R's |
Right: Antimicrobial Dose Frequency Route Duration |
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Tracking Stewardship: Where results are sent |
1. Hospital administration 2. Antimicrobial sub-committee 3. National Health Care Safety Network (CDC) |
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Antibiotic days of therapy (DOT) CDC evaluation: How results are reported back, interpretation |
CDC computes ration: DOT reported/DOT predicted, compares to similar institution results of >1: may have excessive use, <1: may have underuse evaluate discrepancy |
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Role of community RPH in stewardship |
1. Education patients on appropriate antimicrobial use 2. Educate patients on potential ADR, SE 3. Recommendation for symptomatic relief |
