IDM-Alert Antimicrobial Stewardship
Introduction to Antimicrobial Stewardship
Bacterial resistance is driven by the continued use of antimicrobials and the threat of resistance can only be effectively mitigated either by the discovery of new antimicrobials or by a reduction in the use of antimicrobials, in particular broad-spectrum antimicrobials. The already small and dwindling pipeline of antimicrobial drug candidates makes it unlikely that the rescue will come from newly discovered drugs. The only currently available course of action is to find ways of using the existing antimicrobials more prudently. This can be achieved by:
First, to combat resistance, it is important to base the choice to prescribe antimicrobials on the individual patient and the infection concerned with the proper choice of medication, dose, frequency and duration.
Second, it is important that it quickly becomes clear when resistant bacteria are involved and that proper tests are used to determine this.
Third, it is important that healthcare providers carefully follow the antimicrobial guidelines and change medication when appropriate, i.e. when new diagnostic results indicates that change is required, or prolonged treatment is dangerous for the individual patient
Fourth, it is important that healthcare providers carefully follow existing hygiene procedures, such as handwashing, in order to prevent resistant bacteria from spreading.
All these activities together is referred to : “Antimicrobial Stewardship”.
Is your healthcare organisation in control?
When using the IDM-Alert Antimicrobial Stewardship surveillance module, the following questions can be answered for your organisation:
- What is the succes rate in my healthcare organisation of antimicrobial treatment at any timing with:
- the right diagnosis?
- the right drug?
- the right route?
- the right dose?
- the right timing?
- is my staff properly trained for infection management?
- What is the resistance level in my organisation and does it differ from national levels?
- Are there important resistance trends indicating the antimicrobial guidelines should be changed?
- How much antibiotic prescriptions has been registered per ward and specialty?
- Is the infectious diseases specialist always involved when reserved antibiotics are prescribed?
- Are the antibiotic guidelines used and followed by my doctors?
- Is a trend notable of one of the parameters above within certain timeline, specialties and/or wards?
- Which interventions should be started ?
- Are started interventions succesful?
All functionalities supports the PDCA cycle of Good Medical Practice (GMP).
IDM-Alert Antimicrobial Stewardship surveillance is a workflow-based real time Clinical Decision Support System with step-wise role-based authorisation to produce high quality, real-time outcome and triggers. This outcome and triggers can be real time shared with electronic patient record systems and electronic prescription systems. IDM-Alert Antimicrobial Stewardship surveillance is an algorithm-based (scientifically proven algorithms) application using a standardized, normalized clinical data repository. One of the great features of IDM-Alert is the workflow for a hospital-wide AST survey to obtain real-time information about the possible prescription errors, thirty to sixty times faster than classical AST survey, while the performance of IDM-Alert Antimicrobial Stewardship surveillance is significantly better than a classical survey. An interactive report analysis tool has been developed to provide real time information for doctors and hospital staff, to observe problems at certain patient, ward or specialty. This time-saving, worldwide unique solution provides real time daily or weekly management information on AST activities to have the opportunity to start focused PDCA compliant interventions. Succes rate of intervention strategies can be easily analysed using auto-reports.
Schematic overview of IDM-Alert Antimicrobial Stewardship
The review workflow using IDM-Alert
The Clinical Decision Support System of IDM-Alert provide a flexible and easy processable workflow for the Antimicrobial Stewardship Team members. In this example, a 600-bed hospital had (in this example) at the time of point-pfevalence 455 patients admitted to the hospital. From these patients, only 288 were included, according to the AST inclusion criteria. From these 288 included patients, 236 patients (82% were registered automatically as true negative by automated (nested) algorithm. All of these patients were safe according to the AST guidelines.
Only 52 patients (18% of all admitted patients) were selected as suspicious for prescription problems. These 52 patients will be reviewed by AST members using the review module of IDM-Alert. The total process for hospital-wide AST activities using IDM-Alert takes not more than two hours for a 800 bed general hospital .
The review process
The patients selected as suspicious for prescription problems will be presented sequently in the review module. AST members will review these patients and propose an action. These actions will be pushed to the case-management module of IDM-Alert where medical microbiologists, infectious diseases specialists, ICU doctors and pharmacists can start their consultancy tasks.
The final result after one day hospital-wide AST activities
This table represents the result of patients in which antimicrobial medicine advises have been given to physicians. All advises are according the hospital AST guidelines.