initiating ams at bcch

Initiating an Antimicrobial Stewardship Program at

BC Children's Hospital

Quality Forum 2015Ashley Roberts, MD, M.Ed, FRCP(C)

Karen Ng, BSc.Pharm, ACPR, PharmD, BCPSFebruary 19, 2015

Disclosures• We have no conflicts of interest to

declare

Goals of Antimicrobial Stewardship

• Reduce risk of infections• Reduce adverse drug events related to

antimicrobial use• Reduce or stabilize antibiotic resistance• Promote patient safety

“to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use”

BC Children’s Hospital Antimicrobial Stewardship

Program• 180-bed tertiary care

academic hospital and major referral centre for acutely ill or injured children

• Antimicrobial Stewardship Program implemented September 2013

Challenges of Implementing a Pediatric Antimicrobial Stewardship Program

(ASP)

• Limited evidence vs. adult programs for ASP implementation

• Fragilities of neonatal and pediatric population

• Limited evidence and treatment guidelines for pediatric infections

Pharmacother 2012;32(8):735-743.

Key #1

Collaboration• “Collective Ownership”• Promote Mutual Learning

1. CollaborationAntimicrobial Stewardship Team at BC Children’s and Women’s Hospital

ASP Member RoleDr. Ashley Roberts PHSA AMS Director, Infectious Diseases SpecialistDr. Simon Dobson Co-chair, Infectious Diseases Specialist, Infection

PreventionistDr. Karen NgDr. Vanessa Paquette

Clinical Pharmacy Specialists

Dr. Peter Tilley Medical MicrobiologistDr. Srinivas MurthyDr. Rod RassekhDr. Joseph Ting

Pediatric Intensive Care ChampionOncology AMS ChampionNeonatal Intensive Care Champion

Dr. Roxane Carr Pharmacy Clinical Coordinator

Form an effective multidisciplinary AMS team of core members.

1. CollaborationAntimicrobial Stewardship Team at BC Children’s and Women’s Hospital

ASP Member RoleDr. Ashley Roberts PHSA AMS Director, Infectious Diseases SpecialistDr. Simon Dobson Co-chair, Infectious Diseases Specialist, Infection

ControlDr. Karen NgDr. Vanessa Paquette

Clinical Pharmacy Specialists

Dr. Peter Tilley Medical MicrobiologistDr. Srinivas MurthyDr. Rod RassekhDr. Joseph Ting

Pediatric Intensive Care ChampionOncology AMS ChampionNeonatal Intensive Care Champion

Dr. Roxane Carr Pharmacy Clinical Coordinator

Form an effective multidisciplinary AMS team of core members.

PARTNERSHIP WITH MICROBIOLOGY IS ESSENTIAL•Antibiogram production• Bacterial susceptibility breakpoints tailoring and antimicrobial dose

optimization•Microbiology reports and comments modifications•Implementation of new guidelines/initiatives

1. CollaborationAntimicrobial Stewardship Team at BC Children’s and Women’s Hospital

ASP Member RoleDr. Ashley Roberts PHSA AMS Director, Infectious Diseases SpecialistDr. Simon Dobson Co-chair, Infectious Diseases Specialist, Infection

ControlDr. Karen NgDr. Vanessa Paquette

Clinical Pharmacy Specialists

Dr. Peter Tilley Medical MicrobiologistDr. Srinivas MurthyDr. Rod RassekhDr. Joseph Ting

Pediatric Intensive Care ChampionOncology AMS ChampionNeonatal Intensive Care Champion

Dr. Roxane Carr Pharmacy Clinical Coordinator

Form an effective multidisciplinary AMS team of core members.

IDENTIFY ASP CHAMPIONSPhysicians with interest in infectious diseasesPromotes collaboration and acceptance of ASP interventionsExpands opportunities for research

• Example: Partnership with NSQIP (National Surgical Quality Improvement Program)

1. Collaboration

Key #2

Optimize Available Resources

AMS Pharmacist

12

AMS Pharmacist

13

Key #2: Optimize Available Resources

Teamwork-driven daily prospective audit and feedback

• Microbiology liaison

• Infection Control liaison

• Infectious Diseases team

• Partnership with clinical pharmacists

Key #3

Adapt Strategies to Your Site

• Understand local culture and attitudes• Evaluate “worst offenders”• Establish achievable goals

Key #3: Adapt Strategies to Your Site

Strategies Used/Adopted Strategies Bypassed

Daily prospective audit and feedback

Formulary restrictions

Dose optimization Automatic stop ordersEducation, development of guidelines and order sets

Preauthorization requirements

Active surveillanceOngoing research

At BC Children’s Hospital:

Key #3: Adapt Strategies to Your Site

cefotaxime/ceftriaxonevancomycin

1st-gen cephalosporinsamoxicillin/ampicillin

aminoglycosidespiperacillin/tazobactam

metronidazole cloxacillin

clindamycinmeropenem

acyclovirfluconazole

ciprofloxacinmacrolidesamox/clav

voriconazole2nd-gen cephalosporins

sulfamethoxazole-trimethoprimOther

0 50 100 150 200 250 300 350 400 450Cumulative # Interventions in 2014

•Most ASPs target specific antimicrobials in audit and feedback.•BC Children’s Hospital experience: Audit all antimicrobials

Adapting Antimicrobial Stewardship to the Pediatric Population…

Reflections and Lessons Learnt

• Limited evidence requires greater flexibility, discussion and collaboration

• Continual reassessment and readjustment of ASP strategies and initiatives

• Must not forget the humanistic factor • Data collection and analyses are crucial

“from restriction to facilitation”Am J Health Syst Pharm 2011;68:109-10

Summary: Keys to Success

Initiating an ASP in a Pediatric Hospital

1. Collaboration

2. Optimize available resources

3. Adapt strategies to local culture and attitudes

Questions?

Ashley RobertsARoberts6@cw.bc.ca

Karen NgKaren.ng2@cw.bc.ca

604-875-2000 ext 5952Pager: BCCH Antimicrobial Stewardship