Antimicrobial Stewardship: A Ministry Approach J Gavin Cotter MD MPH Director Antimicrobial Stewardship UICOMP Assistant Professor of Clinical Medicine Infectious Disease

OSF Healthcare Owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Illinois. 11 acute care facilities 1 Hospice House OSF Prompt Care 2 Colleges of Nursing OSF Medical Group

OSF Healthcare: Hospitals Saint James-John W Albrecht Medical Center – Pontiac, IL – Beds: 42 Saint Joseph Medical Center – Bloomington, IL – Beds: 149 Saint Luke Medical Center – Kewanee, IL – Beds: 25 Saint Francis Medical Center – Peoria, IL – Beds: 609 Holy Family Medical Center – Monmouth, IL – Beds: 23 Saint Anthony’s Health Center – Alton, IL – Beds: 203 Saint Mary Medical Center – Galesburg, IL – Beds: 90 Saint Elizabeth Medical Center – Ottawa, IL – Beds: 97 Saint Anthony Medical Center – Rockford, IL – Beds: 254 St. Francis Hospital and Medical Group – Escanaba, MI – Beds: 25 Saint Paul Medical Center – Mendota, IL – Beds: 25

OSF ASP Aims To create a formalized Inpatient ASP at OSF SFMC. To support pre – existing inpatient efforts within OSF Healthcare and transition these efforts into formalized Inpatient ASPs. To create new inpatient ASPs within OSF Healthcare. To develop an Ambulatory ASP within OSF Healthcare.

Steps Process Redesign Formed a Powerful Coalition Created a simple vision:

OSF SFMC ASP Action Items Order sets – PNA – CAP/HCAP – Sepsis TheraDoc® EZ-Alerts SCIP Drug Reviews Education Branding – “The antibiotics people.”

OSF ASP Aims To create a formalized Inpatient ASP at OSF SFMC. To support pre – existing inpatient efforts within OSF Healthcare and transition these efforts into formalized Inpatient ASPs. To create new inpatient ASPs within OSF Healthcare. To develop an Ambulatory ASP within OSF Healthcare.

OSF Healthcare: Vision Embracing God's great gift of life, we are One OSF ministry transforming health care to improve the lives of those we serve.

SAMC and SJMC TheraDoc® EZ-Alerts Established PharmD ID position at Rockford Vanco/Aminoglycosides Protocols Centers of Innovation IV to PO CRRT dosing

SAMC Levofloxacin Utilization

OSF ASP Aims To create a formalized Inpatient ASP at OSF SFMC. To support pre – existing inpatient efforts within OSF Healthcare and transition these efforts into formalized Inpatient ASPs. To create new inpatient ASPs within OSF Healthcare. To develop an Ambulatory ASP within OSF Healthcare.

SMMC and SJMC- Pontiac Consolidate Improvements and Produce Still More Change – Education Efforts- Visiting lectures – Speak directly to Local Administration – Pharmacists Trained in ASP – Identify Local Champions

IDPH Collaborative Illinois Collaborative for Hospital Antimicrobial Stewardship Enhancement(ICHASE)

OSF Facilities Participating  Saint Joseph Medical Center  Zosyn®  Saint James-John W Albrecht Medical Center  Levaquin  Saint Mary Medical Center  Levaquin  Saint Francis Medical Center  Meropenem  Saint Anthony Medical Center  Levaquin and Zosyn®

Levofloxacin Criteria for Use

Piperacillin/Tazobactam (Zosyn®) Criteria for Use

Meropenem Criteria for Use

SAMC Piperacillin/Tazobactam Utilization

SMMC Levofloxacin Utilization

SJMC Levaquin Utilization

OSF ASP Aims To create a formalized Inpatient ASP at OSF SFMC. To support pre – existing inpatient efforts within OSF Healthcare and transition these efforts into formalized Inpatient ASPs. To create new inpatient ASPs within OSF Healthcare. More to do! To develop an Ambulatory ASP within OSF Healthcare.

OSF Medical Group: A revisited opportunity. 1 st attempt 2011 – Failure Plea for help – 2014 – Clostridium Difficile A major problem in both inpatient and outpatient settings throughout the ministry. At SFMC 85% of cases originate as outpatient. Order set revised 2012, then again Multiple Service lines concerned. Administrative support

New Outpatient ASP C diff collaborative created Outpatient: – Identify most commonly used antimicrobials – Identify most common infectious diagnoses Education curriculum developed Outpatient Infusion Center – Algorithm – Request reviews

Greatest Lessons Learned Attitudes, Knowledge, Beliefs Communication Branding Data IT is not a barrier Outpatient ASP is a very different culture than Inpatient ASP