Another approach is that of Vidant Medical Center in Greenville, North Carolina.10
This facility utilized a healthsystem–wide electronic medical record to provide offsite prospective chart audits performed by a pharmacist with ID training and the oversight of an ID physician to six community hospitals within the same overall health system. This approach yielded an intervention acceptance rate of 83% to 88% and reduced fluoroquinolone use at two of the four larger remote hospitals.10
In Alaska, the limited road access and shear number of critical access hospitals make the setting a prime example of where telemedicine may increase antimicrobial stewardship access to remote facilities. The Alaska Antimicrobial Stewardship Collaborative uses a telehealth structure to provide critical access hospitals access to an ID physician through twice-weekly conference calls. During these calls, the ID physician provides oversight to local ASP staff performing prospective chart audits. The goals of this program are to increase state-wide access to ID specialists, enhance local ASP audits, optimize antimicrobial therapy, and increase ID training and education in rural Alaska.11
With the changing scope of ASPs in the United States, smaller sites will need to tailor antimicrobial stewardship practices to their facility using alternative techniques and resources. Telemedicine is likely to play a key role in this process. Although telehealth staff are acceptable members of a facility’s ASP team, it is crucial that local stakeholders take responsibility for some aspects of the ASP. Open lines of communication between telehealth and local ASP staff are necessary to promote identification of opportunities for improvement within the ASP and, moreover, assure that antimicrobial therapy is consistently and accurately optimized on the patient level. Continual program assessment and adjustment will be necessary as telehealth is further integrated into ASP models.
Ryan Stevens, PharmD, BCPS, graduated with a doctor of pharmacy from the University of Montana in 2010. After completing a PGY1 pharmacy practice residency at Alaska Native Medical Center in Anchorage, Alaska, he received his board certification in pharmacotherapy in 2012. In 2013, he developed and implemented a comprehensive antimicrobial stewardship program at Providence Alaska Medical Center, where he is currently employed as the infectious diseases clinical pharmacy specialist.