Antimicrobial resistance is a rising concern in the healthcare industry, and effectively managing clinical surveillance in any hospital or intensive-care unit (ICU) is vital to ensuring patient safety and maintaining the highest quality of care. Despite the growing need, antimicrobial management can be both a complicated and costly undertaking for hospitals and caregivers.
Many antimicrobial stewardship programs in a hospital setting rely on manual methods to monitor and then manage hospital-acquired infections (HAIs). As healthcare becomes digitalized and electronic health records (EHRs) are now the standard, implementing clinical decision support (CDS) for antimicrobial stewardship is quickly becoming an essential component to alleviate clinicians’ pain points in managing infectious diseases.
By automating the process of infection control, evidence-based CDS can help clinicians make informed treatment decisions at the point of care by providing real-time recommendations through a single dashboard view of all patients’ current conditions and medications. This helps clinicians to prioritize and treat the most critical patients first to better manage, slow and stop the progression of infections.
The following are CDS technology considerations that hospitals and caregivers should examine to help reduce costly HAIs, which can result from improper treatment of highly resistant bacteria.
De-escalation is a key element within antimicrobial stewardship programs. Physicians may prescribe antibiotics based on hospital antibiograms. (According to the U.S. National Library of Medicine, an antibiogram is “a summary of antimicrobial susceptibilities of local bacterial isolates.”) However, these antibiotics need to be de-escalated to either mono therapy or narrow-spectrum antibiotics once the results of the culture and sensitivity are available. De-escalation of antibiotic therapy is associated with a decreased incidence of multiple drug-resistant organisms (MDROs). The intended outcome is to stop the progression of infectious disease, save lives and reduce length of stay at a hospital, all while optimizing cost effectiveness resulting in potential significant savings.
IV to PO conversion
In order to optimize treatment, improve outcomes and reduce associated costs, data needs to be managed more effectively to improve awareness of the number of days that a patient has been on IV therapy for possible conversion to an appropriate PO (oral) medication. The criteria used to determine whether or not the patient is eligible for PO therapy vary from facility to facility, but they generally encompass the following three key areas:
- Conversion eligibility criteria: Patients on IV therapy for 48-72 hours, with a functioning GI tract, or showing signs and symptoms of clinical improvement (decrease in temperature, white blood cell count [WBC] <15,000/mm3), with the exception of those on steroids.
- Exclusion/caution criteria: Examples include patients with serious infections, such as meningitis and sepsis, NPO status (nothing by mouth) or NG (nasogastric) tube with continuous suction.
- Medication class criteria: Specific medications, such as antiepileptic and cardiovascular medications; patients on those medications could be at higher risk when converted to PO therapy.
What’s next? Leveraging clinical data
So how do hospitals and physician groups address these complexities of treatment of highly resistant and other bacteria? The answer remains in harnessing the power of technology that already exists in many hospitals and physician offices today. By implementing CDS technology, clinicians can view patient information from a wide range of sources – HIEs, EHRs and portals – through the hospital information system (HIS), thus automating this process and alleviating much of the resource burden from the clinical staff.
Additionally, CDS technology supports a facility’s antibiotic de-escalation processes by providing real-time recommendations and analytics through dashboards to end-users, notifying them of patient status updates, such as culture and sensitivity results and number of days a patient has been on antimicrobial therapy and specific broad- and narrow-spectrum medications (to administer per facility guidelines and practices). It also provides recommendations and reports to increase awareness of the number of days that a patient has been on IV therapy for possible conversion to an appropriate PO medication. These real-time data queries optimize treatment, improve outcomes and reduce associated costs. In addition, these queries quickly identify patients with a multi-drug-resistant organism (MDRO) who require isolation, and can advise clinicians regarding appropriate isolation procedures based on the disease or condition of the patient.
Clinical surveillance in your care environment
If your practice is manually handling clinical surveillance, keep in mind that payments from the Centers for Medicare and Medicaid Services (CMS) can be denied for not reporting on quality measures, HAIs and exceeding readmission thresholds. By 2014, 8 percent of CMS payments may be in jeopardy. If 8 percent dramatically impacts your bottom line, then implementing a CDS solution may be a wise approach. CDS enables clinicians to have a single view of patient information to allow actionable information to be delivered in real time at the point of care – when it matters most – in order to impact and improve the quality of care directly and immediately for both the individual patient and entire populations.
With CMS guidelines continuing to include more CDS requirements into their core measures, hospitals and physician practices should seriously consider this vital tool for clinical surveillance. It helps the analysis of key data that is required for antimicrobial stewardship and, in turn, ensures patient safety while reducing unnecessary costs in several ways, including the conversion of antibiotics to a narrower spectrum when appropriate, switching IV to PO, antimicrobial mismatching and appropriate antimicrobial selection. Once all these factors have been calculated, a 600-bed hospital can expect an annual savings of hundreds of thousands of dollars – and possibly upwards of a million or more – by effectively harnessing patient data and providing actionable information where and when it’s needed.
About the author
Fauzia Khan, M.D., FCAP, is chief medical officer and co-founder, Alere Analytics. For more on Alere Analytics, click here.