First few Article Sentences
Kaiser Permanente Southern California’s Regional Infectious Disease (ID) Chief Dr. Kalvin Yu and tertiary medical center ID lead Dr. Jim Nomura implemented a two- site pilot in late 2010 that resulted in over 1,500 hospital patients having expert review of their antimicrobial regimen and up to a quarter of these patients having an improvement made in the dosing, medication or duration of their treatment. For these patients, interventions involved both a change to a more efficacious medication and also took into account protection against developing resistance–so called “super bugs”–that have become endemic in all hospitals. The region is now in the process of adding processes from the pilot to existing antibiotic stewardship efforts across its 11 medical centers.
Antibiotic Stewardship is not a new concept; it is promoted by the Center for Disease Control (CDC) and is also now a requirement by the state of California. It can be done in many ways. The CDC and California recommend a team approach with a physician champion and a pharmacist. Kaiser Permanente’s pilot programs, including most of Northern California under the ID leadership of Dr. Stephen Parodi, is based on the concept of pairing of an ID physician and a two-site pharmacist with advanced training in ID. It also relies on one-to-one communication with ordering physicians. The program can be implemented without extensive information technology and these elements can be adopted by any hospital.
A full-time ID pharmacist pre-screening of key clinical data saves the time of the ID physician, who spends about one-to-two hours per day on this program in a typical hospital with 200 to 300 beds. The pharmacist reviews a list of patients who are receiving antibiotics, identifies new cases, and presents about a quarter of these to the physician. With ID training, the pharmacist develops the expertise to provide consults to other pharmacists, as well as document changes, tracks the status of patients whose regimen has changed and alerts the physicians to any untoward effects.