- CDC educational posters in offices and antibiotic information pamphlets for patients.
- Sharing of “clinical pearls” at monthly practice meetings.
- Surveying the Patient Advisory Council.
- Surveying providers, nurses and medical assistants to gain insights on their knowledge of antibiotic stewardship.
- Identifying a clinical champion in each office to advocate for greater awareness.
Through eBrightHealth, five of Delaware’s leading health care systems have partnered over the past year to improve the quality of patient care through antibiotic stewardship, a success that extends far beyond the boundaries of any single organization. The Choosing Wisely antibiotic stewardship initiative reminds clinicians, patients and families that not all infections, such as viral syndromes, warrant antibiotic treatment. The initiative also seeks to ensure that the right antibiotic is given for the right clinical condition, at the appropriate dose and duration. These best practices help to prevent overuse and misuse of antibiotics, ultimately improving patient outcomes and reducing the spread of infections caused by multi-drug-resistant organisms. The eBrightHealth partners – Bayhealth, Beebe Healthcare, Christiana Care Health System, Nanticoke Health Services and Nemours/Alfred I. duPont Hospital for Children – came together to celebrate the program’s accomplishments on Aug. 8 at Bayhealth’s Kent General Hospital in Dover. To further improve the state’s population health, one specific focus has been the reduction of inappropriate antibiotics for viral upper respiratory infections in the outpatient setting. In addition, hospital-based teams at the partnering health systems have reassessed the use of empiric antibiotics beyond 72 hours in hospitalized patients suspected of having an infection, said Robert Dressler, M.D., MBA, quality and safety officer, Christiana Care iLEAD, and team leader for the Choosing Wisely Initiative. “What we’ve accomplished is impressive, and I think everyone we’ve partnered with should be extremely proud of the work they’ve done,” said Dr. Dressler, a key statewide leader of Choosing Wisely, an international program to improve the quality of care by avoiding unnecessary medical tests, treatments and procedures. Representatives from each of the health systems reported that they increasingly track the correct use of antibiotics and educate hospital stakeholders and outpatient providers about the stewardship campaign. These combined efforts equate to fewer inappropriate uses of these medications across the state. In addition, there are ongoing efforts to educate patients on the difference between bacterial and viral infections, since the vast majority of upper respiratory infections are caused by viruses and antibiotics shouldn’t be used for these infections. The use of antibiotics in these clinical situations exposes the patient to the risks of side effects with no clinical benefits. Team leaders say their success is the result of monthly teleconference calls to solve problems and share learnings. There also have been quarterly meetings to coordinate efforts across a broad group of interested parties, such as the Delaware Division of Public Health, Delaware Health Information Network, Long-term Care Facilities Association and Quality Insights, a non-profit that strives to improve the services of Medicare and Medicaid. In addition, the teams have formed working groups within their individual hospitals. “This is wonderful to see,” said Gary Siegelman, M.D., senior vice president and chief medical officer, Bayhealth. “The work that’s been done to improve our population health through antibiotic stewardship is tremendously important. It’s beneficial to patients throughout Delaware and reflects what we ought to do as clinicians in being judicious in how we provide care.” The findings are all the more significant when considering that at least 30 percent of antibiotics are unnecessarily prescribed in outpatient centers, according to the U.S. Centers for Disease Control and Prevention (CDC), which has launched a national campaign to improve stewardship. Overuse of antibiotics also is associated with risks for patients of adverse drug events, Clostridium difficile (C. diff) infection and the development of antibiotic resistance within acute-care hospitals and long-term care settings. A growing body of evidence demonstrates that hospital-based programs dedicated to the improvement of antibiotic use, commonly referred to as antibiotic stewardship programs, can optimize the treatment of infections and reduce adverse events associated with antibiotic use, said Lauri Hicks, D.O., a medical epidemiologist and director of the CDC’s Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion. Dr. Hicks spoke by Skype to the August gathering and praised the strategic partnership of eBrightHealth. “I thank you for what you’re doing in your local area to make a difference,” Dr. Hicks said. “Partnerships such as yours are critical for implementation, evaluation and education around antibiotic stewardship.” Christiana Care team leaders gave two reports at the Bayhealth meeting, one dealing with the progress in ambulatory clinics and a second dealing with hospital use of antibiotics. Christiana Care Infection Prevention Officer and Hospital Epidemiologist Marci Drees, M.D., MS, FACP, DTMH, and Infectious Disease Pharmacist Jillian Laude, Pharm. D, reported on success in the ambulatory clinics. At Christiana Care’s five Medical Aid Units and 14 primary care provider offices, total antibiotic use per 100 patient visits declined by 40 percent from December 2016 to June 2018, and the use of azithromycin declined by 86 percent. Efforts have included the following: