Hawaii - Pacific Chapter of ACHE Mobile - Spring 2016 Edition

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An Update on Antimicrobial Stewardship Programs in Hawai‘i Hospitals

Jen Dacumos, PharmD, MBA

Improving the use of antibiotics is an important patient safety and public health issue as well as a national priority. Past research has shown that 20-50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. Like all medications, antibiotics have serious side effects, including adverse drug reactions and Clostridium difficile infections.  Patients who are exposed unnecessarily or inappropriately to antibiotics are placed at risk for these events with no clinical benefit. The Centers for Disease Control and Prevention (CDC) estimates that more than two million people are infected with antibiotic-resistant organisms, resulting in approximately 23,000 deaths annually. The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious threats to public health.   

A growing body of evidence demonstrates that hospital based programs dedicated to improving antibiotic use, commonly referred to as Antibiotic Stewardship Programs (ASPs), can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. In 2014, the CDC recommended that all acute care hospitals implement ASPs. There is also anticipation that both the Centers for Medicare & Medicaid and The Joint Commission will publish regulatory measures related to hospital-based ASPs sometime in 2017.

Last Spring, the Hawai‘i Department of Health and the Daniel K. Inouye College of Pharmacy at the University of Hawai‘i at Hilo launched the Hawai‘i Antimicrobial Stewardship Collaborative (HASC). The primary goals of HASC are to:

  • Assist facilities in implementing and sustaining ASPs.
  • Reduce target antimicrobial use as measured by Days of Therapy (DOT) or Defined Daily Doses (DDD) per 1,000 patient days.  Target antimicrobials have been identified as the Carbapenems (meropenem, ertapenem, imipenem and doripenem) and linezolid.
  • Reduce healthcare-onset C. difficile infection rates per 10,000 patient days by 15%.

Participating facilities are: Castle Medical Center, Hilo Medical Center, Kahuku Medical Center, Kapi‘olani Medical Center for Women & Children, Kaua‘i Veterans Memorial Hospital, Kona Community Hospital, Kuakini Medical Center, Maui Memorial Medical Center, North Hawai‘i Community Hospital, Pali Momi Medical Center, Rehabilitation Hospital of the Pacific, Straub Clinic & Hospital, The Queens Medical Center, Tripler Army Medical Center, Wahiawa General Hospital, and Wilcox Memorial Hospital.  HASC leadership holds educational conference calls or webinars at least once per quarter. Ongoing communication and technical assistance visits by project staff to help facilities identify, develop, and refine existing ASP practices is also offered.

If you are looking for more information on hospital based ASPs, the CDC website is an excellent first stop. The CDC has published Core Elements of Hospital ASPs, which can be summarized as follows:

  • Leadership Commitment.  Dedicating necessary human, financial and information technology resources.
  • Accountability.  Appointing a single leader responsible for program outcomes.  Experience with successful programs shows that a physician leader is effective.
  • Drug Expertise.  Appointing a single pharmacist leader responsible for working to improve antibiotic use.
  • Action.  Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e. “antibiotic timeout” after 48 hours of therapy).
  • Tracking.  Monitoring antibiotic prescribing and resistance patterns.
  • Reporting.  Regularly reporting information on antibiotic use and resistance to the appropriate healthcare team(s) and stakeholders.
  • Education.  Educating clinicians about resistance and optimal prescribing practices.

For more information, please visit: http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html


Centers for Disease Control and Prevention.  Core Elements of Hospital Antibiotic Stewardship Programs.  Available at:
http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html/  Accessed March 4, 2016.

 State of Hawai‘i, Department of Health, Disease Outbreak Control Division.  Hawai‘i Antimicrobial Stewardship Collaborative.  Available at: http://health.hawaii.gov/docd/dib/hawaii-antimicrobial-stewardship-collaborative-hasc/.  Accessed March 4, 2016.

Photo courtesy of:  http://thecompanion.in/the-misuse-of-antibiotics-can-be-deadly/

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