Antibiotic Stewardship: The Current State in Tennessee

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2 Antibiotic Stewardship: The Current State in Tennessee Jeff Binkley, PharmD, BCNSP, FASHP Co-Chair, Tennessee Pharmacists Coalition Administrative Director of Pharmacy Maury Regional Medical Center

3 Tennessee Pharmacist Coalition Vision Reduce harm and preventable adverse drug events through directed inquiry into current pharmacy practices, identify medication safety-gaps, and make recommendations for best practice across Tennessee.

4 Tennessee Pharmacist Coalition Goals Inspire pharmacist s engagement Align partners & agencies efforts on medication safety Identify performance measures Collaborate to spread best practices Provide education and resources for pharmacists and schools of pharmacy

5 Statewide Collaborative Partners

6 Recognition July 2014 ASHP Journal article CMS/Partnership for Patients National webinars Medication Safety Affinity Group webinars CMS Community of Practice website and electronic newsletters Endorsed by THA Board of Directors

7 Strategies for Improvement Changing the culture Identified measures for ADE reporting Target pharmacy directors/ medication safety officers Assist hospitals with data collection processes

8 Strategies for Sustainability Formation of the Tennessee Pharmacist Coalition Work groups with targeted focus areas Data review for successes and improvement opportunities Educational webinars Presentations at statewide and regional meetings Website to share deliverables and resources Provide updates to THA Board of Directors for consideration

9 THA Board of Directors Endorsed Antibiotic Stewardship Recommendations Demonstrate commitment to antibiotic stewardship via a written statement of support for dedicated pharmacy, clinician, and IT staff time for antibiotic stewardship activities All hospitals commit to reporting to the National Healthcare Safety Network antimicrobial use and resistance modules within specified timeframes All hospitals commit to a policy requiring documentation of indications for antibiotic therapy

10 THA Board of Directors Endorsed Antibiotic Stewardship Recommendations All hospitals commit to implementing a policy requiring an antibiotic review after hours to allow for appropriate review. Participation by hospitals in an antibiotic stewardship collaborative to encourage best practice, sharing, and education.

11 Antibiotic Stewardship NHSN Survey Questions Number of Participating Hospitals: 2014: : 100

12 NHSN Hospital Survey Question #11 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

13 NHSN Hospital Survey Question #12 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

14 NHSN Hospital Survey Question #23 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

15 NHSN Hospital Survey Question #24 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

16 NHSN Hospital Survey Question #25 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

17 NHSN Hospital Survey Question #26 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

18 NHSN Hospital Survey Question #27 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

19 NHSN Hospital Survey Question #28 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

20 NHSN Hospital Survey Question #29 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

21 NHSN Hospital Survey Question #30 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

22 NHSN Hospital Survey Question #31 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

23 NHSN Hospital Survey Question #32 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

24 NHSN Hospital Survey Question #32 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

25 NHSN Hospital Survey Question #32 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

26 NHSN Hospital Survey Question #32 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

27 NHSN Hospital Survey Question #33 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

28 NHSN Hospital Survey Question #34 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of T.C.A

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30 Antibiotic Stewardship Survey Fall, 2016 Preparation for Medication Safety Summit on Antibiotic Stewardship

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32 Top 5 Antibiotics by Use Rocephin Vancomycin Levofloxin & Zosyn 12 Cefazolin Azithromycin Meropenem 4 Cipro Avelox, Bactrim DS, Clindamycin, Gentamicin, Macrobid & Metronidazole

33 14 Top 5 Antibiotics by Cost Daptomycin Vancomycin Zosyn Meropenem & Teflaro 8 7 Zyvox 6 6 Ertapenem & Tygacil 5 Azatam & Rocephin Azithromycin & Doxycycline Avycaz, Bicillin LA, Cefepime & Levofloxin 0 1 Amikacin, Amphotericin B, Avelox, Cefazolin, Cefoxin, Cleocin, Clindamycin, Nafcillin, PCN G, Primaxin, Rifampin, Zerbaxa

34 25 Top 5 Organisms Encountered E. coli Pseudomonas 17 Enterococcus Klebsiella & Staph. aureus 12 MRSA Proteus mirabilis 6 MSSA 5 4 Coag neg. Staph Candida Albicans, E.Cloaccae & Streptococcus alalactiae

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38 Antibiotic Stewardship: New Standards

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40 Antibiotic Stewardship: Resources