VHA Inc. Helps Hospitals Avoid Inappropriate Use of Antibiotics

Drug resistant-organisms continue to threaten public health in hospitals across the nation. To help hospitals identify, understand and manage antibiotic resistance issues and improve patient safety and outcomes, VHA Inc., the national healthcare alliance, launched a “Bugs and Drugs" program through its regional office in Trevose, Pa. Since the program’s launch in 2007, VHA member hospitals in the region have improved antibiotic stewardship, creating a safer environment for patients and reducing pharmacy costs.

The program allows hospitals to identify infections or pathogens that are not responding to previously used antibiotics and make necessary dosage changes or drug changes to ensure the bacteria are effectively treated.

 “A vital step in improving infectious disease outcomes is managing antibiotic resistance – the physiologic ability of infectious organisms to adapt to drug treatment, enabling new and stronger ‘superbugs,’” said Vivien Ng, RPh, CCP, director of performance improvement and Bugs and Drugs program coordinator at VHA’s East Coast office. “By coordinating multidisciplinary efforts with appropriate targeted antibiotic therapy, we are helping VHA member hospitals improve and implement measures for responsible and successful antibiotic stewardship.”

As part of this program, VHA has collaborated with John G. Gums, Pharm. D., Professor of Pharmacy and Medicine at the University of Florida and helped feed information into the University’s Antimicrobial Resistance Management (ARM) database. Gums and his colleagues have identified trends and tracked drug resistance patterns across the country. Leveraging VHA’s expertise in pharmacy spend analytics, and the data from the ARM program, VHA members can gain insights into ways to improve care and reduce costs. 

The VHA “Bugs and Drugs” program’s innovative feature is the quantitative analytic report that identifies antibiotic resistance issues. Using statistical modeling, the report shows the resistance patterns of bacteria to various antibiotics over time and provides a predictive component in proactive management of antibiotic use by clinicians.    

“Comparing resistance data with antibiotics utilization data allows us to begin to understand why resistance issues are happening and predict where problems may arise,” said Gums. “We found that the bulk of resistance is being driven by the antibiotics that hospitals are purchasing.”

One hospital that has had tremendous success with the Bugs and Drugs program is Hunterdon Medical Center in Flemington, N.J. The medical center piloted the program in 2006 because it wanted to improve antibiotic utilization patterns, and since has been able to discover how hospital usage was affecting resistance patterns at their facility.

“The Bugs and Drugs program allowed us to impact resistance patterns,” said Robert M. Pickoff, MD, MMM, chief medical officer at Hunterdon. “Through the assessment phase, we received eight recommendations for improvement, which we implemented -- and the results have been impressive. Our work has captured the full support of administration, the board of directors and medical staff.”

Through the program, Hunterdon realized the following results in 2007:

-- Saw a 24 percent improvement in susceptibility of Klebsiella pneumonia to antibiotics. This bacteria can cause pneumonia, but more commonly causes hospital-acquired urinary tract and wound infections, particularly in people with weakened immune systems.

-- Saw a 25 percent improvement in susceptibility of Pseudomonas aeruginosa to antibiotics. This bacteria causes urinary tract infections, respiratory system infections, dermatitis, soft tissue infections, bacteremia, bone and joint infections, gastrointestinal infections and a variety of systemic infections, particularly in patients with severe burns and in cancer and AIDS patients who are immunosuppressed.

-- Achieved a total pharmacy cost savings of $139,145 and an antimicrobial cost savings of $51,699 by clinical pharmacist interventions alone.

-- Since January 2008, the hospital has seen a total pharmacy cost savings of $70,553 and an antimicrobial cost savings of $21,966.

The results from the VHA Bugs and Drugs program will be presented at the joint meeting of the American Society for Microbiology and Infectious Diseases Society of America in October.

Source: VHA