Sonoma Valley Hospital Recognized for Innovative Program to Improve Use of Antibiotics and Other AntimicrobialsMarch 20, 2013
March 15, 2013–Sonoma Valley Hospital (SVH) has garnered international attention and been recognized by the California Department of Public Health for its innovative telemedicine-based antimicrobial stewardship program (ASP).
The state-mandated program is designed to address overuse of antibacterials that contribute to the increase in resistant organisms (MRSA, VRE, ESBL) that threaten patient safety and drive up costs unnecessarily.
“At SVH, the key to the program has been its collaborative approach, involving the hospital’s physicians, microbiologists, pharmacists, and infection control nurse in weekly patient care conferences and daily review of antibacterials in use,” says Courtney McMahon, SVH Infection Control Coordinator. “Key elements of the program are delivered via telemedicine, which SVH has been using since 2007 to provide patients with access to a number of specialties, including infectious disease. Telemedicine has allowed us to provide the same specialty care patients would expect at top academic medical centers.”
To implement its ASP, SVH formed a multi-disciplinary hospital-based committee that meets weekly via telemedicine with the offsite infectious disease specialist. The group reviews how susceptible different types of bacteria are to antibiotics, evaluates the prescribing patterns of physicians to identify areas of potential overuse and misuse, and designates specific classes of drugs to be targeted. The group’s first targets were two broad-spectrum antibiotics (fluoroquinolones and piperacillin/tazobactam) with subsequent additions including antifungal medications, medications to treat methicillin-resistant Staphylococcus aureus (more commonly known as MRSA), and carbapenems (another class of broad-spectrum antibiotics).
The Sacramento-based (he’s no longer with UC Davis—he left there to start his own private practice, all via telemedicine, called TeleMed2U) offsite infectious disease specialist, Dr. Javeed Siddiqui, helps educate SVH physicians through participating (via telemedicine) in multidisciplinary rounds, department meetings, and direct consultations about appropriate use of both targeted drugs and antibiotics in general. He emphasizes the impact of appropriate prescribing on the quality of care and encourages physicians to send cultures to the laboratory for evaluation. This can facilitate the use of narrow-spectrum antibiotics made to target the specific bacteria instead of prescribing broad-spectrum drugs without identifying the underlying organism.
“By moving away from “shot gun” prescribing methods, physicians are improving treatment effectiveness and reducing the risk that the bacteria may become more drug resistant over time,” says McMahon.
Additionally, all antimicrobial orders are reviewed by the hospital pharmacist and specific orders are selected for review with the offsite infectious disease specialist, who may contact the prescribing physician to recommend considering a different (typically more narrow spectrum) drug.
“We’ve been very pleased with our results,” says McMahon. “We have seen significant improvements in the way drugs are prescribed to treat patient infections and we have reduced use of two target classes of broad-spectrum drugs. Two common bacteria, E. coli and P. aeruginosa, also showed a decline is drug resistance during the period.”
In addition to the recognition from the California Department of Public Health, SVH has received significant peer recognition for its program, which is featured on the AHRQ Health Care Innovations Exchange, a publication (it’s a website: http://innovations.ahrq.gov/ of the Agency for Health Care Research and Quality. In October 2012, the Infectious Disease Specialist Dr. Siddiqui and Ms. McMahon presented their abstract “The Application of Telemedicine in Anti-microbial Stewardship” at “ID Week”, a joint international conference between IDSA, SHEA, and HIVMA, in San Diego, CA.
“Our telemedicine program is one more illustration of how technology enables community hospitals to deliver the best quality care, while allowing patients to remain in their home communities,” says Dr. Robbie Cohen, Chief Medical Officer at Sonoma Valley Hospital. “Patients truly need not travel outside the area to benefit from the latest medical advances.”