A Success Story: Wyoming Hospital Launches Program To Reduce Antibiotic Resistance

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SWEETWATER COUNTY — The Memorial Hospital of Sweetwater County has been working on an Antibiotic Stewardship program that likely will have a positive impact on health outcomes for decades.

Antibiotics have transformed health care to reduce infections that were once lethal. However, 20 to 50 percent of all antibiotics prescribed in U.S. acute care hospitals are unnecessary or inappropriate, according to the Centers for Disease Control and Prevention. Antibiotics can have harmful effects and can also increase antibiotic resistance in patients – making infections harder to treat and control.

“This definitely has the potential to impact the entire community and overall population health,” said Amanda Molski, the director of quality for Memorial Hospital. “Since it’s a global initiative we are now part of a national movement contributing on a global level. Knowing we are able to contribute to our entire community is very aspiring.”

Background & Educational Outreach

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Memorial Hospital started its Antibiotic Stewardship (AS) program in 2016 after knowing it was a national and local need. Once the hospital’s leadership saw value in the initiative, it chose an AS lead to champion the project. The lead is a trained pharmacist versed in AS. The hospital then trained its staff about the importance of AS using materials from the CDC, the Joint Commission’s Speak Up Campaign and Mountain-Pacific Quality Health. Outpatient clinic staff was involved in choosing which handouts and materials they would use for patient education to give them ownership of the program.

To further ownership and buy in from staff on the program, the hospital ordered statement of commitment posters from Mountain-Pacific that described the commitment of the hospital and individual doctors. The posters featured a physician’s picture, signature and hospital logo along with the commitment verbiage. The hospital also included stewardship-related duties in its position descriptions and job evaluation criteria to further its commitment to the program.

With the staff trained and waiting room education materials in place, Memorial Hospital then focused on public outreach aimed at educating its community on the importance of antibiotic awareness. The campaign included radio ads, Facebook posts, the hospital’s website and local newspaper articles. The campaign’s messaging asked patients to inquire if an antibiotic was really needed: “How can you help? When you have a cough, sore throat or other illness, tell your doctor you only want an antibiotic if it’s really necessary.”

Providing Prescribing Guidelines & Next Steps

Once the public was touched by the messaging of the campaign, the AS team implemented tools to guide antibiotic prescribing practices. Clinicians at the hospital use evidence-based diagnostic criteria and treatment recommendations to guide decision making through computerized algorithms. Each individual guideline has a reference section where the evidence-based criteria were obtained, giving clinicians the sources of information. The pharmacy team at the hospital is also available for additional support to staff and its patients alike.

One of the steps to reduce antibiotics is to implement the process of delayed prescribing practices and/or watchful waiting, when appropriate. The hospital is in the midst of adopting this process. Clinicians are also slated to receive education and best practices on delaying and watchful waiting practices.

Data will pinpoint the impacts of the program and its results. Memorial Hospital has been diligently working with its information services, pharmacy, informatics, infection prevention, family practice and nursing teams to implement four main goals and measurements to track. Also, the hospital plans to hire a unit pharmacist that will be dedicated to medication reconciliation, medication management, as well as provide provider and patient education in an effective manner.

“It’s definitely an ongoing piece of work, but I think is has been viewed positively,” Molski said. “Our next steps are applying the information and it’s going to take a lot of boots on the ground. But I have no doubt our investment in this program will have a lasting impact.”

5 Things You Should Know About Antibiotics

Hospital pharmacy director offers some tips

SWEETWATER COUNTY – Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die as a direct result of these infections.

Many more people die from other conditions that were complicated by an antibiotic-resistant infection, according to the Centers for Disease Control and Prevention.

The use of antibiotics is the singlemost important factor leading to antibiotic resistance around the world. Antibiotics are among the most commonly prescribed drugs used in human medicine. However, up to 50 percent of all the antibiotics prescribed for people are not needed or are not optimally effective as prescribed. Antibiotics are also commonly used for promoting growth in food animals, one type of use that is not necessary.

U.S. Antibiotic Awareness Week – Nov. 13-19 – is an annual one-week observance to raise awareness of antibiotic resistance and the importance of appropriate antibiotic prescribing and use.

Here’s a quick Q&A about antibiotics with Renee Petty, Memorial Hospital of Sweetwater County pharmacy director.

  1. What are antibiotics used for?
  2. Antibiotics should be used only to treat bacterial infections. When you are sick you don’t know if you have an infection caused by a bacteria, virus or fungus. Antibiotics ONLY kill bacterial infections. Viruses and fungus are completely unharmed by antibiotics.  Two good examples of illnesses not caused by bacteria are the common cold and bronchitis. These illnesses are caused by viruses and antibiotics will not have any effect on these infections. Typically, your body’s immune system will fight off these infections.  
  3. My mucus is green. Isn’t that an indicator that I need antibiotics?
  4. No. It is not a sign that an antibiotic is needed. Green mucus is a sign that your immune system is hard at work. The color green in mucus comes from an iron-containing enzyme released by the white blood cells to attack the infection. When the white cells explode in the attack, the iron is released making the mucus green. And just because you have an infection doesn’t mean you need antibiotics. Earlier we learned that many illnesses are caused by viruses.
  5. Do ear infections require an antibiotic?
  6. Some do and some don’t. Most ear infections are viral, meaning the virus will not be harmed by an antibiotic. However, some ear infections are bacterial and may require antibiotics. The only way to tell is to have your physician do a thorough exam of the infection.
  7. Does a sore throat require an antibiotic?
  8. No. Most sore throats are caused by viruses and the virus will not be harmed by an antibiotic.  Most viruses will be successfully fought off by our immune systems. Some sore throats can be caused by bacteria but your physician will need to do a thorough exam of your throat to determine the cause of your infection.
  9. What are the potential risks when taking an antibiotic?
  10. There are lots of germs. When we take antibiotics we do not need, or start and stop them without sticking to the full course of treatment, we expose all of the germs in our body to them. This gives germs the opportunity to “learn” how to build up defenses against the antibiotic. This is called “antibiotic resistance”. Some germs are so smart they share their tricks with other un-related bacteria. These smarter bacteria can simply hide out in our bodies waiting for our immune system to become weak to create a new infection, resistant to antibiotics. We also can pass these modified germs along to other people whose immune systems may not be strong.

In addition to resistance, antibiotics kill “good bacteria” that live in our gut, opening us up to takeover by the “bad bacteria”.