Utilizing a multi-faceted antimicrobial stewardship (AMS) programs can not only help a facility combat antibiotic-resistant infections, but it can also lead to cost savings even when it’s not a focal point of those efforts.
John Russillo, clinical pharmacy manager at Concord, California-based John Muir Health, spoke to HealthExec at HIMSS 2017 about how his system embraced AMS after government reports of the growing threat of antibiotic resistance and the establishment of these programs by CMS and the Joint Commission.
Hospitals had plans to combat infections long before this, of course, but Russillo said stewardship programs are far more formalized and have more dedicated resources by connecting infectious disease (ID) physicians and hospital pharmacists.
“Their interests are aligned with yours,” he said. “In years past, we used to have rely on recommendations or get ID consults to get things changed and it wasn’t a formal program.”
AMS programs will have measurable goals and clear criteria. Russillo said using a system-wide surveillance and reporting, John Muir can break antibiotic usage down by unit type, location and physician, as well as look at trends across patient days or months.
Under this program, use of broad spectrum antibiotics is examined within three days. By that time, Russillo said results from lab tests and imaging can be evaluated to decide whether more narrow-spectrum antibiotics or using no antibiotics would be more appropriate for the patient.
There was little resistance to implementing an AMS program, according to Russillo. Clinicians considered it an improvement over murkier standards which preceded it, and specialists weren’t bothered because allowed more discretion in ordering antibiotics than hospitalists. For executives, they were sold on the promised efficiency and the improvement on quality measures.
“So we were very lucky because the way we positioned it with the C-suite was that this was a win for everybody,” he said. “It reduces workload for certain people, it saves money, it reduces resistance rates and it reduces utilization. We really had very little opposition.”
Having been place in place two years, the AMS program has resulted in measurable positive outcomes. Russillo said use of very powerful antibiotics, like carbapenems, has gone down, as well as many other broad-spectrum treatments to use which was “more appropriate,” according to Russillo.
Overall, mortality rates went down, along with length of stay, and critical care stays for antibiotic-resistant infections like C. diff, vancomycin-resistant enterococci (VRE) and Linezolid-resistant enterococci (LRE). And yes, the system saved about $60,000 just in annual drug costs, even if reducing spending wasn’t the main goal.
“By impacting unneeded antibiotic use, you can actually impact your C. diff rates,” Russillo said. “That also translates to huge cost savings because one C. diff case, between treatment and extended length-of-stay, is thousands of dollars.”
The next step, he said, is getting clinicians make more appropriate selections of antibiotics upfront.
“We’re doing a lot more education, and then built into our (electronic medical record) is all this kind of guided information on picking the appropriate antibiotic,” Russillo said.