Supercharging the Veteran Administration’s Antimicrobial Stewardship Efforts

Every year, at least 2 million people are infected with antibiotic-resistant bacteria, and at least 23,000 people die as a result. On top of the human toll, the nation spends more than$2 billion annually treating antibiotic-resistant infections.

Antibiotic resistance is forcing healthcare leaders, infectious disease doctors and supply chain experts to rethink many of their go-to treatments. As organisms morph to resist antibiotics, staying on top of new and proven antibiotics and technologies is now a requirement for providers. Sepsis, for example, requires clinicians to quickly identify the culprit bacteria so they can administer the correct antibiotic.

A recent Premier® analysis shows that hospitals are improving their care for patients who present with sepsis, in part by optimizing the pharmacy to treat this condition more quickly and effectively. They’re also employing clinical surveillance programs in a multitude of ways, including using the antibiogram feature to demonstrate their hospital’s typical antibiotic resistance and susceptibility pattern, so clinicians can choose the most effective antibiotic for their patient population.

A similar best practice is emanating from the U.S. government, which is taking steps to slow the emergence of superbugs and the spread of antibiotic-resistant infections by embedding technology-driven antimicrobial stewardship programs into veterans’ healthcare. One program has already shown how using the right enabling technology saves more than $2 million, while another demonstrated improved patient outcomes and reduced both adverse drug events and costs. If scaled, these systems could foster savings and improved outcomes for veterans nationwide.

Technology prompts cost-saving interventions through automated record reviews and appropriateness criteria.

Three Veterans Health Administration medical centers (VAMCs) in Martinsburg, West Virginia, Washington, D.C., and Baltimore decided to align their individual antimicrobial stewardship programs in 2015 and collaborate using a clinical surveillance system. Partners at DSS, Inc., a health information company, integrated the clinical surveillance technology into the VAMCs' IT systems to help them analyze data and improve antibiotic prescribing outcomes, and saved an estimated $2.3 million in just two years.

The clinical surveillance system helped clinicians and pharmacists identify the overuse of antibiotics and drug-bug mismatch, reduce time to appropriate therapy and enhance therapy for difficult-to-treat pathogens. Key to the VAMCs’ success was the clinical surveillance system’s automated record review for each patient and daily alerts for pharmacists and other members of the antimicrobial stewardship team.

Armed with the clinical insights and tools to help monitor patients and identify potential interventions, the three VAMCs nearly tripled the number of pharmacy interventions prompted by antimicrobial concerns in one year, from about 3,000 in 2016 to more than 10,000 in 2017.

The technology led clinicians to adopt interventions that improved care for veterans, including:

• Switching patients to narrower and less expense antimicrobials.
• Eliminating redundant antimicrobials.
• Shortening duration of drug therapy to guideline-recommended length of time.
• Restricting the use of certain drugs without approval of an infectious disease specialist.

Infection prevention reaches new heights with customizable reports and the ability to pinpoint emerging outbreaks.

At South Texas Veterans Healthcare System (STVHS), the same clinical surveillance technology identified and targeted patients who had – or were at risk of developing – antibiotic-resistant infections, resulting in improved patient outcomes and reductions in both adverse drug events and costs.

An effective clinical surveillance tool can also proactively identify patients who are at risk for harmful drug interactions, yielding actionable data for decision-makers in real time. Pharmacy staff and clinicians at STVHS could screen and track antibiotic treatment, quickly flagging patients on ineffective or no antibiotic therapy or predicting interactions between drugs that could harm patients or compromise treatment.

At the same time, STVHS used the clinical surveillance tool to track emerging infection outbreaks using a bed-trace mechanism that automatically identified patients for appropriate isolation. Throughout STVHS’s efforts, customizable reports reduced labor-intensive work such as reviewing printed reports and manual data entry – one of the main obstacles that can limit the effective implementation of antimicrobial stewardship by overburdened clinicians.

These interventions saved the VA system an estimated $241,756 in one year and reduced the risk of adverse drug events for veterans under STVHS’s care.

We’re not stopping here.

Premier and our members are engaged in many other efforts around antimicrobial stewardship and are committed to reducing antibiotic resistance.

Looking for ways to supercharge your antimicrobial stewardship efforts? Contact us and download our data-driven report, Margin of Excellence: Lowering the Incidence and Severity of Hospital-Associated Sepsis, to learn how clinical surveillance is leading to cost-savings and improved outcomes for the nation’s most costly condition.