HOW CAN INNOVATION IN ID MANAGEMENT HELP YOUR HOSPITAL’S STEWARDSHIP PROGRAM? Introducing the latest innovation from Merck Healthcare Services & Solutions (HSS)...
The challenges of antimicrobial stewardship Approximately 1 out of every 2 hospitalized patients is administered at least 1 antibiotic, up to 50% of which are not needed or are not optimally effective as prescribed.1,2 This inappropriate prescribing can lead to resistant infections. Each year in the United States, at least 2 million people are infected with antibiotic-resistant bacteria, which leads to approximately 23,000 deaths annually.2 It can also result in preventable allergic reactions, adverse drug reactions, and Clostridium difficile (C difficile) infections, from which at least 14,000 more people die each year in the United States.3 These infections add considerable and avoidable costs to the already overburdened US healthcare system. In most cases, antibiotic-resistant infections require prolonged and/or costlier treatments, extend hospital stays, and necessitate additional doctor visits and healthcare use. To address this urgent concern, The Joint Commission has implemented an Antimicrobial Stewardship Standard, MM.09.01.01, which became effective January 1, 2017. This Standard incorporates 8 Elements of Performance (EPs), which include4: 1. Leaders establish antimicrobial stewardship as an organizational priority. 2. The hospital educates staff and licensed independent practitioners involved in antimicrobial ordering, dispensing, administration, and monitoring about antimicrobial stewardship practices. 3. The hospital educates patients and families regarding the appropriate use of antimicrobial medications. 4. The hospital has an antimicrobial stewardship multidisciplinary team. 5. The hospital’s antimicrobial stewardship program (ASP) includes the 7 Core Elements of Hospital ASPs from the CDC. 6. The hospital’s ASP uses organization-approved multidisciplinary protocols. 7. The hospital collects, analyzes, and reports data on its ASP. 8. The hospital takes action on improvement opportunities identified in its ASP. This is a significant undertaking that requires health information technology (HIT) resources.
“The only way hospitals of any size can truly get ready is with the appropriate support of information technology. We cannot underestimate the critical role IT plays in stewardship.” Debra A. Goff, PharmD, FCCP, Clinical Associate Professor and Infectious Diseases Specialist, The Ohio State University Wexner Medical Center
ILÚM HEALTH SOLUTIONS: Lighting the way to improved outcomes ILÚM was created by Merck HSS to help healthcare institutions leverage HIT to better manage infectious disease patients and enhance ASPs. As an enterprise-wide Infectious Disease management service, ILÚM enables improved outcomes by delivering real-time information from across the health system that supports patient management decisions and program improvement.
ILÚM supports hospitals in achieving their quality goals in Infectious Diseases in 3 key areas: • E nables comprehensive, data-driven antimicrobial stewardship through automated decision support, as well as prospective patient and program monitoring • K eeps clinicians, program leaders, and hospital administration connected to the latest healthcare data in their institution, helping to achieve the best outcomes and achieve actionable insights to support hospital performance • Helps prioritize patients at both the case and cohort levels based on program priorities The ILÚM approach combines the latest evidence-based guidelines with an integrated technology solution that supports care teams by delivering insights within their existing workflows. ILÚM also tracks clinical and quality indicators through an automated reporting capability, enabling program leaders to quickly identify and address opportunities for improvement. Guidelines from the Infectious Diseases Society of America (IDSA) and The Joint Commission emphasize the need for HIT resources to support stewardship.4,5 Computer-based surveillance can facilitate good stewardship by more efficient targeting of antimicrobial interventions, tracking of antimicrobial resistance patterns, and identification of nosocomial infections and adverse drug events.5 For ASPs to be optimized fully and truly make a viable long-term impact on patient outcomes, HIT must be employed.6 ILÚM enables the measurement of outcomes to demonstrate the impact and value of HIT on antimicrobial stewardship.
“HIT needs to give antibiotic foresight, not just hindsight. While many factors account for the systemic overuse and inappropriate use of antibiotics, a key issue is the lack of timely clinical information at the point of care.” Brandon Palermo, MD, MPH, Chief Medical Officer, ILÚM Health Solutions
Committed to evidence One of ILÚM’s early efforts focused on clinical decision support for the management of sepsis and resulted in7,8: • Improved identification of patients with severe sepsis and high adherence to guideline-based care • Greater than 80% adherence rate to established care pathways,including administration of appropriate antibiotics • Significantly improved clinical outcomes, including reduction inmortality, hospital length-of-stay, and hospital-onset septic shock
Sepsis-associated mortality rates 8 Sepsis-associatedfollowing mortalityimplementation rates following implementation
All-cause mortality rates following implementation8 50
50
40
40
30
23.2%
Patients, %
Patients, %
All-cause mortality rates following implementation
20
7.9%
10
0
n=13
30
19.6%
20
5.9%
10
n=12
n=11
0
n=9
Odds ratio (95% CI), 0.26 (0.09, 0.74) P=0.0063
Odds ratio (95% CI), 0.28 (0.11, 0.74) P=0.0067 Control group (N=56)
Study group (N=151)
Adherence to guideline-based care over 12 months8 100% 80% 60% 40% 20% 0%
Sept & Oct 2015
Nov & Dec 2015
Jan & Feb 2016
ABx within 90 min Serum lactic acid within 90 min
ABx, antibiotics; IV, intravenous.
Mar & Apr 2016
May & Jun 2016
IV fluids within 90 min Repeat lactate within 6 hrs
Jul & Aug 2016
A shared commitment to protecting patients and driving value Ask yourself these important questions: 1. Has our hospital considered clinical solutions that improve coordination, automation, and efficiency for our antimicrobial stewardship and sepsis initiatives? 2. Have we considered ways to improve the value and impact of our antimicrobial stewardship efforts by automating the labor-intensive tasks associated with collecting, analyzing, and reporting data? 3. How open are we to partnering with third-party companies that have the resources and technology needed to support automation and coordination in support of our ASP? ILÚM is expanding its partnerships with hospitals and health systems that share a commitment to better manage infectious disease patients and improve the use of antibiotics.
To learn more about ILÚM, or for a demonstration, visit www.ilumhealthsolutions.com or contact Glenn Borgmann at
[email protected]
References: 1. Magill SS, Edwards JR, Beldavs ZG, et al. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA. 2014;312(14):1438–1446. doi:10.1001/jama.2014.12923. 2. Centers for Disease Control and Prevention. Get smart: overview. www. cdc.gov/getsmart/week/overview.html. Accessed May 3, 2017. 3. Alliance for the Prudent Use of Antibiotics. CDC “vital signs”: C. difficile infections. http://emerald.tufts.edu/med/apua/consumers/consumers---practioners---cdc-vital-signs.shtml. Accessed May 3, 2017. 4. The Joint Commission. Approved: new antimicrobial stewardship standard. Jt Comm Perspect. 2016;36(7):1–8. 5. Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–177. doi:10.1086/510393. 6. Kullar R, Goff DA, Schulz LT, et al. The “epic” challenge of optimizing antimicrobial stewardship: the role of electronic medical records and technology. Clin Infect Dis. 2013;57(7):1005–1013. doi:10.1093/cid/cit318. 7. DePaula J, Merwin C, DeCorte R, et al. Sepsis care improvement through an automated clinical decision support solution at East Jefferson General Hospital. Poster presented at: Institute for Healthcare Improvement 28th Annual National Forum on Quality Improvement in Health Care; December 4–7, 2016; Orlando, FL. 8. DePaula J, Merwin C, DeCorte R, et al. A novel automated clinical decision support solution reduces mortality in patients with severe sepsis. Poster presented at: The Society for Healthcare Epidemiology of America Spring 2017 Conference. March 29–31, 2017; St Louis, MO.
