1. Infectious Disease Using Antimicrobials Responsibly
Jennifer Williams, PhD, RN, ACNS-BC
Director of Nursing Research

2. Disclosures
I have nothing to disclose

4. Current State

5. What Do We Know?
30-50% of antibiotics prescribed in hospitals are unnecessary or inappropriate
Multi-drug resistant bacteria are frequently seen in our communities
Healthcare costs continue to rise due to extended length of stay or length of treatment course
Antimicrobial stewardship interventions have demonstrated positive outcomes for patients and healthcare costs

6. Inpatient Settings
More than half of all inpatients receive an antibiotic
Inconsistent use of standard guidelines to address infectious illness leads to variability in prescribing practices
Antibiotic use can lead to increased incidences of Clostridium difficile infections- responsible for 14,000 deaths annually

7. Antimicrobial Stewardship

8. Outpatient Settings
Majority of antimicrobials taken by humans are prescribed in an outpatient setting
High frequency prescribing for common outpatient diagnosis- many cases are likely viral in origin
Otitis Media
Pharyngitis
Sinusitis
Narrow Spectrum versus Broad Spectrum

9. Outpatient Settings Patient/Family Expectations
Lack of clinical guidelines/stewardship programs
Prevention of adverse drug reactions, antimicrobial-associated infections

10. Long Term Care Settings
Common Medication
Prevalence of 47-79%
25-75% of those prescriptions are inappropriate
Indication
Dose
Duration
More developed relationships between residents and local providers
Can result in some “precautionary prescribing” when covering providers are involved
Limited availability of testing

11. Individual influence

12. Influences on Prescribing
Patient characteristics
Critically ill
Immunocompromised
Allergies
Tolerability
Efficacy
Past Experiences
Risk of Missing Infections

13. Influences on Prescribing
Financial
Cost to patient
Cost savings to the organization
Hospital/Organization Antibiogram
Patient Factors
Patient request
Patient expectations
Provider expectations

14. Influences on Prescribing
Guideline Recommendations
Clinical Practice Development
Journal Review

15. Prescriber Characteristics
“Newness”
Confidence with difficult conversations
Protocol guided support
Peer support

16. Inpatient Case Study

17. Outpatient Case Study

18. Long Term Care Case Study

19. References
Buckel, W. R., Hersh, A. L., Pavia, A. T., Jones, P. S., Owen-Smith, A. A., & Stenehjem, E. (2016). Antimicrobial Stewardship Knowledge, Attitudes, and Practices Among Health Care Professionals at Small Community Hospitals. Hospital Pharmacy, 51(2), doi: /hpj
Drekonja, D. M., Filice, G. A., Greer, N., Olson, A., MacDonald, R., Rutks, I., & Wilt, T. J. (2015). Antimicrobial Stewardship in Outpatient Settings: A Systematic Review. Infection Control & Hospital Epidemiology, 36(2), doi: /ice
Fleming, A., Bradley, C., Cullinan, S., & Byrne, S. (2015). Antibiotic Prescribing in Long-Term Care Facilities: A Meta-synthesis of Qualitative Research. Drugs & Aging, 32(4), doi: /s
Fleming, N. (2016). Antimicrobial stewardship: The appropriate use of antibiotics. Practice Nursing, 27(8), doi: /pnur
Kaki, R., Elligsen, M., Walker, S., Simor, A., Palmay, L., & Daneman, N. (2011). Impact of antimicrobial stewardship in critical care: a systematic review. Journal of Antimicrobial Chemotherapy (JAC), 66(6), doi: jac/dkr137
Ladenheim, D., Rosembert, D., Hallam, C., & Micallef, C. (2013). Antimicrobial stewardship: the role of the nurse. Nursing Standard, 28(6), doi: /ns e7802
Morgan, D. J., Croft, L. D., Deloney, V., Popovich, K. J., Crnich, C., Srinivasan, A., Leekha, S. (2016). Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship. Infection Control & Hospital Epidemiology, 37(7), doi: /ice
Morgan, S. A. (2016). Antimicrobial stewardship and you. American Nurse Today, 11(5),
Ness, V., Price, L., Currie, K., & Reilly, J. (2016). Influences on independent nurse prescribers' antimicrobial prescribing behaviour: a systematic review. Journal of Clinical Nursing, 25(9/10), doi: /jocn.13249
Schuts, E. C., Hulscher, M. E. J. L., Mouton, J. W., Verduin, C. M., Stuart, J. W. T. C., Overdiek, H. W. P. M., Prins, J. M. (2016). Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infectious Diseases, 16(7), doi: /S (16)
Wagner, B., Filice, G. A., Drekonja, D., Greer, N., MacDonald, R., Rutks, I., Wilt, T. J. (2014). Antimicrobial Stewardship Programs in Inpatient Hospital Settings: A Systematic Review. Infection Control & Hospital Epidemiology, 35(10), doi: /678057
Yam, P., Fales, D., Jemison, J., Gillum, M., & Bernstein, M. (2012). Implementation of an antimicrobial stewardship program in a rural hospital. American Journal of Health-System Pharmacy, 69(13), doi: /ajhp110512