Outsmarting Resistant Infections - Episode 14
Importance of Technology & Data Within Antibiotic Stewardship Programs
Peter L. Salgo, MD: Who’s tracking all of this? Is the computer tracking it at this point?
Debra Goff, PharmD, FCCP: So, that’s the component of stewardship that’s really, really hard. Who is compiling all of this data? And you have to have your hospital IT people on board because that is a full-time job. Someone’s got to generate these reports. I say it’s our job to only ask for the most meaningful reports that you can use to go to your CEO, when our pharmacy budget increases—because we’re using the more expensive agents because they’re the right antibiotics—and justify it. So, you’ve got to have some outcome metrics that IT allows you to generate these reports, and that’s a key component of it.
Peter L. Salgo, MD: So, you’re expecting IT to understand clinical necessity.
Debra Goff, PharmD, FCCP: No. They’re at our stewardship meeting. They have to be there to understand everybody’s competing for their time and you’ve got to prioritize; we need this to accomplish that. And these are hospital goals, they’re not just individual stewardship people who go, “I think I’d like to know this.” So, it’s important to work collaboratively.
Peter L. Salgo, MD: So, Mr. or Ms. IT asks you, “What are your goals? What are the goals of this program?”
Debra Goff, PharmD, FCCP: So, if our rates of C. diff (Clostridium difficile) that are publicly reported are very high and the hospital administration has made that a key goal for the hospital, at a stewardship meeting, I’m going to ask the IT people, “Can you create lists?” There’s an alert when a new PPI gets put onboard with a patient who’s already on antibiotics or generating alerts when there’s 3 antibiotics ordered and the patient’s already on a PPI. So, there are ways you strategize to figure out who is the highest-risk patient to get C. diff in your hospital instead of me trying to look at every antibiotic, every PPI. That is an unbelievably time-consuming way to approach it. So, the IT people could really help you. And so, when they understand they have the power to make a difference in rates of C. diff, they’re actually helping patient care. You have to teach them that. Like if I can’t get this report from you, I can’t help them. When you ask people to do more work, there’s got to be a good reason, and if they really feel they’re contributing to a bigger cause, they will agree to do it. So, it’s part of how you ask them to do this.
Jason Pogue, PharmD, BCPS-AQID: I agree to that, it’s very important if you do make an impact. So, let’s say that we’ve figured out how to make that an alert and we don’t want to have all those risk factors, and we respond to that alert in real-time, we decrease this and that, feeding that data back to them is so important. So, you’ll see reporting come up as one of these core elements of stewardship. It’s getting that data back. We asked for a lot at my institution of our pharmacists and of our physicians when we revamped vancomycin dosing. They had to do a whole lot of extra steps because we thought it would be safer, and it was safer. And so, I go to the pharmacy meeting and I say, “Look at these numbers. Look, we were able to do this.” And, again, that gets that buy-in and that reinforces the importance of what you’re trying to do, which is ultimately improve patient outcomes.
Andrew Shorr, MD: But I think it’s important to realize that stewardship as an endeavor is really still very nascent in its emergence. And there are lots of things that are being tried, and there has been a lot of one-off; I tried, it didn’t work, it worked. And we need to move into an area where the science of quality is quality science. And we’re finally beginning to see some actual clinical trials in stewardship approaches comparing approach X to approach Y, and I think that’s really where we’re going to get on the steep part of the curve in terms of benefit. Because I think we’re still down here on the S. And when we start having randomized controlled trial data and we really are focused on a tool for a better kind of approach, we can actually start to apply that and say, “Oh, you know what, the no upfront strategy is a fail, and this is the cost. But an audited feedback approach clearly offers benefits, and it’s easier to change physician behavior because that’s what this is all about with evidence.”
Peter L. Salgo, MD: Sure. When I see people strategizing about antibiotic therapy, they go, “Oh gosh, ID is not going to approve this, but I really want it.” Wouldn’t it be easier to say they won’t approve it because we have this data, this data, this data as opposed to “I don’t like you”?
Jason Pogue, PharmD, BCPS-AQID: The other thing is that they might be right in asking for it, and I think it’s so crucial that we work with those end users of why do you want to use this. If it’s a recurring thing, what is it that you think or know that’s driving this and if it’s appropriate, then give it to them and allow them to use it up front and then pull back. Again, I found in my experience, even with what people would consider to be difficult people to work with is that, and maybe that’s me, but difficult people to work with…
Andrew Shorr, MD: At least you didn’t say me.
Jason Pogue, PharmD, BCPS-AQID: I don’t work with you directly, right?
Peter L. Salgo, MD: But he was thinking it.
Jason Pogue, PharmD, BCPS-AQID: Of course, he’s my poster child. But, again, if you work with them and get everybody on the same page—and then to Deb’s point, it starts to take care of itself—then I can focus my effort to a different area, and you can hit more parts of the hospital.