ANTIMICROBIAL STEWARDSHIP

ICU Bullet Rounds

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Tim T.Y. Lau, PharmD, FCSHP Pharmacy Lead, ASPIRES, VCH

Clinical Supervisor & Infectious Diseases/ Antimicrobial Stewardship Pharmacist, VGH

Clinical Professor, Faculty of Pharmaceutical Sciences, UBC

Daljit Ghag, PharmD Antimicrobial Stewardship Pharmacist,

ASPIRES, VCH Clinical Instructor,

Faculty of Pharmaceutical Sciences, UBC

On behalf of the ASPIRES Team: Dr. Jennifer Grant, Salomeh Shajari, Felicia Laing

Conflicts of Interest

• None to declare

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Outline

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1. Antimicrobial Stewardship in the ICU? 2. How were ICU bullet rounds implemented? 3. What is the intent of the ICU bullet rounds? 4. Does It Make a Difference? 5. Future Projects

What is Antimicrobial Stewardship?

• Promote and optimize appropriate antibiotic use • Accreditation Canada Required Organization Practice, Clinical

Care Management • ASPIRES (Antimicrobial Stewardship Programme) under Quality

& Patient Safety at Vancouver Coastal Health

• Education • Prescribing Tools and Resources • Measurement and Evaluation • Clinical Interventions: Audit and Feedback Mainstay of

AMS

Antimicrobial Stewardship Activities?

In the ICU

• Why is Antimicrobial Stewardship needed in the ICU?

Broad-Spectrum & Reserved Antibiotics Utilization

Acute Care Wards, VGH

Broad-Spectrum & Reserved: Daptomycin, Vancomycin (Inj), Ceftazidime, Piperacillin-tazobactam

In the ICU

• Stakeholder engagement and feedback

• Audit and feedback (A&F)

• Variable uptake of recommendations

• Disruptive to ICU team rounds

• Limited impact

Then, re-visited in February 2015

• Formal and regularly scheduled A&F

ICU Bullet Rounds

• Prospective rapid A&F

• Meet twice weekly (Tues, Fri)

• ICU staff and/fellow with Pharmacist

• 3 teams

– Review patients

– Provide recommendations

– Provide education

– Open forum for questions from ICU teams

ICU Bullet Rounds • All patients reviewed for antimicrobials

– Goal is to optimize therapy for infection and patient factors:

• Indication

• Dose

• Route

• Frequency

• Duration

• Co-morbidities (eg. Transplant, BMT population)

• Renal/Hepatic function

• Allergies

ICU Bullet Rounds

• Interventions

– Narrow therapy

– Streamline to a single agent

– Infection vs. colonization

– Duration of therapy

– Cephalosporin use in penicillin allergic patients

– Infectious Diseases services consult

Education

• Academic half day

– Role of Antimicrobial Stewardship in the ICU

– VAP guidelines and algorithm

– Clinical pearls of common infectious etiologies

Does Antimicrobial Stewardship make a difference?

• Enhanced multi-disciplinary relationship with Infectious Diseases, Microbiology, and Pharmacy

• Increase in Infectious Diseases consults from 2014-2015

– 31 47

Broad-Spectrum & Reserved Antibiotics Utilization Acute Care Wards, VGH

Broad-Spectrum & Reserved: Daptomycin, Vancomycin (Inj), Ceftazidime, Piperacillin-tazobactam

Key Lessons

• Critical care area

– Requires collaboration with ICU stakeholders

– Education opportunities to optimize prescribing practices

– Evaluation to provide feedback and seek opportunity to improve program

– Dynamic environment, requires flexibility with scheduling

Sustainability

• Increase ICU rapid fire rounds to 3 times per week as more resources allocated to the ASPIRES programme

• Collect additional data to quantify impact of ASPIRES

• Quality Improvement initiatives

– Work on treatment protocols with high needs groups (e.g. BMT, SOT)

Questions