Department of Pharmacy Practice, South Dakota State University College of Pharmacy and Allied Health Professions, Brookings, SD, and Avera Health Antimicrobial Stewardship Program, Avera McKennan Hospital and University Health Center, Sioux Falls, SD.
Avera Queen of Peace Hospital, Mitchell, SD.
Am J Health Syst Pharm. 2019 Jan 16;76(2):108-113. doi: 10.1093/ajhp/zxy012.
The stages of development of a health system-wide antimicrobial stewardship program (ASP) using existing personnel and technology are described.
Small hospitals with limited resources may struggle to meet ASP requirements, particularly facilities without onsite infectious disease physicians and/or experienced infectious disease pharmacists. Strategies for ASP development employed by Avera Health, a 33-hospital health system in the Midwest, included identifying relevant drug utilization and resistance patterns, education and pathway development, and implementation of Web-based conferencing to provide pharmacists throughout the system with access to infectious disease expertise on a daily basis. These efforts resulted in an evolving single-system ASP that has leveraged existing resources to overcome some system barriers. Program outcomes to date include a reduction in the use of a targeted agent, improved pathogen susceptibility trends, and rates of hospital-associated Clostridium difficile infection below national benchmarks.
The Avera Health ASP grew from a collaborative project targeting levofloxacin overuse and resistance among key bacteria to a formal, health system-wide ASP in a rural setting. This program used existing personnel to provide standardized processes, educational campaigns, and antimicrobial expertise through the use of technology. This ASP program may provide helpful examples of ASP strategies for other rural health systems with similar resources.
描述使用现有人员和技术发展全系统抗菌药物管理计划（ASP）的各个阶段。
资源有限的小医院可能难以满足 ASP 的要求，特别是没有现场传染病医生和/或经验丰富的传染病药剂师的医疗机构。中西部拥有 33 家医院的 Avera 健康中心采用了以下策略来开发 ASP：确定相关的药物利用和耐药模式、教育和途径制定、以及实施基于网络的会议，以使整个系统的药剂师能够每天获得传染病方面的专业知识。这些努力促成了一个不断发展的单一系统 ASP，利用现有资源克服了一些系统障碍。迄今为止，该计划的成果包括减少了一种靶向药物的使用、改善了病原体敏感性趋势、以及医院相关艰难梭菌感染的发生率低于国家基准。
Avera 健康中心的 ASP 从针对左氧氟沙星在关键细菌中的过度使用和耐药性的合作项目发展成为农村地区的正式、全系统的 ASP。该计划利用现有人员通过技术提供标准化流程、教育活动和抗菌药物专业知识。这个 ASP 计划可能为其他具有类似资源的农村卫生系统提供有帮助的 ASP 策略示例。
