08-22-2012 02:08 PM - edited 08-22-2012 03:31 PM
Thanks for joining our webinar with Davey Legendre on "Antibiotic Stewardship: Implementation of a Program in a Hospital Setting."
Have a question for Dr. Legendre? Post it here where he is answering questions for a limited period of time.
08-22-2012 03:04 PM
Here are questions from today's live presentation:
08-23-2012 03:06 PM - last edited on 08-23-2012 03:20 PM by HeatherQ
1. With regard to de-escalation efforts, do you see advantages in many of the new rapid identification processes for micros or biomarker data? How might pharmacists begin to evaluate the benefits of using this data within an ASP?
The rapid identification processes give you information quicker, but there is debate about whether the results will help with deescalation and stewardship efforts. I am one of the doubters that the information delivered will encourage a prescriber to change practice with other available data.
2. Would you suggest targeting specific services (ie, ICU, surgery) with ASP services?
Absolutely, you should target services based on local data, and the ICU is a usual place to start.
3. How effective have ASPs been in oncology populations? Are there data showing similar benefits to general populations?
ASPs are expected to be effective in oncology populations. The only data that I'm aware of involved BMT units where there is a tremendous amount of antibiotic use due to the diminished (or absent) immune system of the patient.
4. Is there data connecting ASPs to lower HAIs?
There is data that ASPs lower HAIs. The best data right now comes from the CDC in response to C dif. A simple pubmed search gives ample results.
5. How do you communicate recommendations when your institution is a paperless system?
In a paperless system, pharmacists use the order entry system to communicate to other pharmacists and/or the power chart to document clinical activities.
6. Earlier in your presentation you mentioned that most hospital CEO's & CFO's, that you have worked with are unwilling to hire an outside company to build or asses their anti-microbial program and I was wondering why you think this is?
Its expensive, and its very difficult to convince hospitals to put money up front.
7. We have just recently had our first stewardship program. Any recommendations on initial items to add to the agenda? As of right now we are looking at all antibiotics by class trying to limit the formulary.
Control of the formulary is imperative, so that's a good start. Consider adding criteria or restrictions to antibiotics with high resistance liability. Start with easy programs (such as IV to PO, renal dosing, and pharmacokinetics) and add targeted antibiotic interventions as the program progresses.
8. Are more hospitals moving in the direction of utlizing software to monitor Antibiotic Stewardship, interventions and outcomes?
More hospitals are moving to utilizing software. I have not had the opportunity to evaluate such systems in a real setting.
9. How do you involve the ID Mds in the ASP? Are they typically paid for this?
We typically just ask them for the good of the patient population. Most are more than happy to participate. If the physician is independent, they may ask for payment, but paying for this service is still rather rare.
10. Because much of what is considered done today in Antimcirobial Stewardship, has been done for 20 years of more, do you think that is creating an issue with now trying to put what may be a formal program?
There is more pressure, becuase we have finally reached the end of the road. There are no new antibiotics coming, and stewardship is no longer optional. What ensues is typically a political battle between practitioners and stewards.
11. What approach does your stewardship program use for surgical prophylaxis ?
Antibiotics are not necessary (or have limited efficacy) for many surgeries. The key to stewardship is in line with core measures, which is to use limited options in a brief (usually less than 24 hours) fashion. I absolutely stay aware from ertapenem for surgical prophylaxis due to development of high level resistance.