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Note: This story originally appeared in VCH News on June 25, 2015.
Meet Dr. Tim Lau, an infectious disease pharmacist, and Dr. Jennifer Grant, an infectious disease physician/medical microbiologist. As project leads for the ASPIRES team — the Antimicrobial Stewardship Program: Innovation, Research, Education & Safety team — they share the HEABC Collaborative Solutions Award with a region-wide group of dedicated professionals.
ASPIRES, part of the Four Cornerstones regional initiative to reduce health care-associated infections, launched three years ago to educate clinicians on how to optimize antimicrobial use to improve patient care.
“One of our most important medical challenges is maintaining the efficacy of antibiotics — not just for people with infections, but for those whose immune systems are compromised for necessary medical care,” says Jennifer.
“Without antibiotics, many forms of chemotherapy, immunotherapy and care of newborns would not be possible, or successful. I’m hoping that if we’re careful, we can keep doing the things that we do to make people live longer, happier lives.”
ASPIRES uses a multi-faceted approach that includes pocket references, pre-printed orders to guide treatments, online intranet resources and educational in-service sessions (e.g. Grand Rounds). Its most effective strategy, however, is “prospective audit and feedback” discussions.
Tim and Jennifer, as well as Drs. Daljit Ghag and Titus Wong, review patients who are on target microbial therapies and then sit down with physicians and pharmacists to discuss the rationale behind their choice of prescriptions while also reviewing culture and lab results.
“Then we provide input where there are opportunities to optimize treatments,” says Tim. “This allows us to tailor our recommendations for their practice, which over time, encourages good prescribing practices and better targeted interventions.”
Since launching its audit and feedback program in August 2013, ASPIRES has recommended interventions on 1,226 patients with an acceptance rate of 78 per cent at VGH.
“This has resulted in 2,980 avoided days of antibiotic therapy on our targeted medical services,” says Tim. “Since the launch of the C. difficile infection (CDI) quality assurance initiative in collaboration with Infection Control and Four Cornerstones, 99 per cent of CDI-positive patients are now followed by a clinical pharmacist to ensure treatments are optimized. Overall, we’ve seen a reduction in broad-spectrum and targeted intravenous antibiotics usage.”
Similar interventions have been initiated at Lions Gate Hospital, where Dr. Gabe Loh and Isla Drummond have intervened on 266 patients since October 2013, and at Richmond Hospital, where Drs. Jerry Vortel and Sandra Chang have intervened on 127 since April 2014.
VGH clinical nurse educator Doris Bohl has nothing but praise for ASPIRES. She and the nursing staff on Sub Acute Medicine (CP7) and the Acute Hospitalist Medical Unit (CP 10 D) were part of the first group to implement the ASPIRES urinary tract infection (UTI) management algorithm to reduce UTIs caused by indwelling Foley catheters.
“All I can say is thank you ASPIRES for developing this algorithm,” says Doris. “It’s made a big difference in how we care for our patients.”
Tim says receiving this award is a huge honour.
“It’s a great feeling to know that our efforts are recognized as an important initiative. More importantly, our accomplishments are the result of the hard work by all our clinicians, as they’re the ones who are most responsible for optimizing antimicrobial prescribing and patient outcomes, so this is actually an award to acknowledge their achievements in improving patient care,” he says.
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