Antimicrobial Stewardship Initiative’s Hospital Collaborative

In 2012, the Oregon Patient Safety Commission and the Oregon Health Authority created the Oregon Antimicrobial Initiative with funding from the Oregon Department of Justice. This initiative included support for improved outpatient antimicrobial use through the Alliance Working for Antibiotic Resistance Education, a survey of Oregon hospitals’ current stewardship practices, one-day trainings for interested hospitals, and a 12-month quality improvement collaborative for hospitals ready to commit the time and energy required.

Collaborative Dates Collaborative Participants November 2012 to November 2013  Columbia Memorial Hospital Collaborative Structure  Doernbecher Children’s Hospital  Lake District Hospital The Collaborative included learning sessions for all participants to learn best  Mid-Columbia Medical Center practices together and share strategies with each other, conference calls and  Randall Children’s Hospital webinars to provide additional content and help participants remain  Rogue Regional Medical Center connected between meetings, and site visits to provide expert consultation to  Sacred Heart Medical Center teams and leaders while ensuring continued progress. From November to  Salem Hospital March, collaborative staff worked with hospitals to prepare for  Salmon Creek Medical Center implementation of activities. Hospitals began formal implementation of  Samaritan Albany Hospital antimicrobial stewardship activities in mid-March 2013.  Samaritan North Lincoln Hospital  Sky Lakes Medical Center Recommended Strategies  Willamette Valley Medical Center All Collaborative participants received education and resources related to key antimicrobial stewardship strategies and then implemented the strategies most applicable to their own settings. Recommended strategies included:

 Post-prescriptive review by pharmacists oregonpatientsafety.org  Avoidance of double anaerobic coverage [email protected]  IV to PO conversion protocols 503-928-6158  De-escalation protocols (particularly related to vancomycin)  Appropriate treatment of Clostridium difficile infections  Extended infusion protocols  Development of standard order sets and use of local antibiograms The potential for impact was reduced due Outcomes to the limited 12-month timeframe for this intervention, early challenges to implementation for some hospitals, and obstacles posed by EHR implementations during the collaborative period. Nonetheless, antimicrobial prescribing decreased significantly in adult hospitals. In particular, prescribing of broad- spectrum, gram-negative agents appear to have decreased the most with promising post-intervention trends. Greater improvements are anticipated for these hospitals in the future as they continue to strengthen their programs on their own.