In 2013, Alameda Health System’s Highland Hospital, in Oakland, Calif., brought together seven departments to foster antimicrobial stewardship and tackle the hospital’s rate of Clostridium difficile (C.diff) due to antibiotic exposure.
As one of the busiest emergency departments in Alameda County, Highland had 80,000 visits that year and clinicians recognized that antibiotic stewardship could begin with initial treatment and admission. Led by a new director of Infection Control and the addition of a clinical pharmacist specialist, the initiative aimed to reduce unnecessary antibiotic usage and simultaneously reduce the risk of C.diff to patients. Using this collaborative approach, Highland Hospital reduced its C. diff rate due to antibiotic exposure by 68.2 percent between 2010 through the second quarter of 2014.
In December 2012, through the partnership between pharmacy and infection control, Highland Hospital conducted a prospective audit for antimicrobials deemed at high risk for inappropriate use. The audits by clinical pharmacy provided real-time findings that allowed for targeted care interventions. Based on the audits, attending physicians and residents were paged with recommendations once the pharmacist consulted with the microbiology laboratory. The infectious disease clinical pharmacist found physician champions and provided real-time education for the oft-changing medical residents. Using this approach, antibiotic use dropped by more than 50 percent within Highland Hospital. The partnership between infectious disease practitioners and clinical pharmacy specialists improved communication between many previously disparate departments, including the microbiology laboratory, emergency department physicians and hospitalists, and nursing.
Capitalizing on the success of the collaboration, the hospital expanded and revitalized its Antimicrobial Stewardship Committee in late 2013 to create consensus policy regarding antibiotic usage within Highland Hospital. The eight-member committee represented seven key departments: infectious disease, medicine, emergency, surgery, microbiology laboratory, pharmacy and quality. Representatives from each met quarterly to review data, developed and published antibiograms, made updates to empiric therapy guide for the management of common infection syndromes and the antimicrobial formulary, and assessed antimicrobial usage. The committee provided advice on guidelines for the prospective audit carried out by the pharmacy, making it a consensus practice instead of one driven by a single department. By having each of these departments participate on the committee, the prospective audit became part of an arsenal of collaborative infection control practices to reduce C.diff.
With continued vigilance of prospective audits and continued communication among hospital departments, Highland Hospital demonstrates the value of collaborative efforts to promote antimicrobial stewardship.