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MO hospital changes drug therapy more effectively for critical patients

St. Luke's Hospital, Chesterfield, MO, serving greater St. Louis, is Missouri’s only hospital recognized by HealthGrades® America's 50 Best Hospitals™ in 2007, 2008 and 2009.

Situation:

In 2007, pharmacy initiated an antimicrobial stewardship program. Each day pharmacists manually reviewed positive culture reports looking for “bug-drug” mismatches and de-escalation opportunities for narrower spectrum therapy. When intervention was deemed appropriate, a pharmacist put a note in a patient’s chart. But relying on final positive cultures often resulted in treatment change delays from 48 to 72 hours, which was not ideal.

Solution:

In 2008, SafetySurveillor was installed to automate a wide range of strategic patient safety initiatives, including enhanced antimicrobial stewardship efforts with real-time pharmacy and infection prevention alerts. Alerts automatically identified issues such as optimal duration of therapy, “bug-drug” mismatches, early identification and evaluation of bacteremic patients, and significant resistance patterns including extended spectrum beta-lactamase producers or any vancomycin resistant Enterococci..

Results:

A three-month study comparing the manual process with the SafetySurveillor-enhanced system showed:

Intervention counts increased 50 percent while retaining similar physician adherence rates
Increased from two to 24 the number of patients in which the length of therapy was affected significantly
Intervened in 13 cases 48 to 72 hours earlier using real-time, critical-to-patient-outcome alerts
12 of 13 were accepted by physicians immediately – a 92 percent acceptance rate
Increased physician acceptance and acknowledgement of these critical, pharmacy-driven patient safety initiatives and a growing comfort that such recommendations are not only valid but potentially life-saving

"We get alerts 48 to 72 hours before we would have gotten them before SafetySurveillor. In three months we identified 13 cases where we were able to intervene before anybody else... 12 were accepted immediately... I’m not saying they wouldn’t have been caught in the old system, but they wouldn’t have been caught by the pharmacy, and there would have been delay. There is plenty of information in the literature that supports the idea that delay of appropriate antibiotics or antimicrobials in septic patients leads to increased mortality. All the interventions were accepted within one to six hours...There was a high success rate..."

Erik Schindler, Clinical Pharmacist
St. Luke's Hospital

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