News Room

Small Hospital Starts Program to Ensure Appropriate Antibiotic Use

Efforts Are the Result of Recent New Mexico MRSA Collaborative Participation

Albuquerque, NM – While participating in the New Mexico Methicillin-resistant Staphylococcus aureus (MRSA) Collaborative, an effort started by the University of New Mexico Health Sciences Center (UNMHSC) with assistance from the New Mexico Medical Review Association (NMMRA) that concluded last summer, Gerald Champion Regional Medical Center (GCRMC) in Alamogordo began an antimicrobial stewardship program to help assure appropriate antibiotic use, reduce antibiotic resistance, improve patient outcomes and reduce the cost of unnecessary or ineffective antibiotics.

According to the Centers for Disease Control and Prevention (CDC) antibiotic use promotes development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria, like MRSA.

The New Mexico MRSA Collaborative involved a series of workshops for knowledge sharing among health care facilities and addressed development of community standards of infection control, data collection tools, educational materials for the public and health care providers, and data analysis. It included small rural and larger urban acute care and long-term care facilities in the state with efforts generally aimed at reducing health care-associated bacteremias specifically caused by MRSA.

As a result of its participation in this collaborative, GCRMC launched a program to address inappropriate antibiotic use in its 99-bed hospital. The program involves daily pharmacist review of the culture and sensitivity (C&S) reports from the laboratory. Initially, laboratory personnel assisted pharmacy staff in reading and interpreting the report. If a patient has an infection, it's critical to know which antibiotics will be most effective. This means that the type of bacteria (or other pathogen) causing the infection must be identified through testing, and the drugs most effective at inhibiting their growth must be determined.

“Participating in the MRSA collaborative made us feel that we could make a difference,” said Marti Heinze, RN, GCRMC infection control practitioner, “even if our facility is a small one.” Heinze thought about the C&S reports and wondered if a different approach could be used to make better use of them. She decided that one change could be to have the reports printed directly in the pharmacy.

“Now, the staff pharmacist on duty reviews the C&S report and then checks the patient’s chart to determine the appropriateness of the antibiotic the patient is receiving,” explains GCRMC pharmacist Mary Jo Garst, RPh. “If the antimicrobial isn’t identified or the sensitivity data isn’t available, the chart is marked to recheck the following day. If it is determined to be ineffective, the pharmacist then contacts the patient’s physician to recommend an antibiotic change and the results are recorded.”

Involving physicians was critical to the success of the effort, and most were receptive to the change and their response has been positive. “Because of the efforts given by the pharmacists, particularly Mary Jo,” said George Laws, MD, hospitalist, “we now receive reminders when we are not so timely on addressing the identified infection. They are able to suggest the most appropriate antibiotic and it has been beneficial to both us [physicians] and the patient. It is so helpful to have them looking out for, and advocating for, the patient, and in turn, the doctors.”

An evaluation of GCRMC’s new process found that from July 1 through September 30, 2009, pharmacists reviewed 277 charts and contacted physicians for antibiotic changes 23 times, resulting in 22 changes to more appropriate antibiotics. Pharmacists spent an average of just 10 minutes a day processing the C&S report and reviewing patient charts.

Garst adds that GCRMC’s new process is “an example that a simple program can have a positive impact on the use of antibiotics” and “reviewing the C&S reports and the patients’ charts have taken much less time than anticipated.”

Garst recently presented a poster about GCRMC’s Antimicrobial Stewardship program at the December mid-year clinical meeting of the American Society of Health-system Pharmacists in Las Vegas, Nevada. To learn more about efforts at GCRMC, contact Marti Heinze, RN, infection control practitioner, at mheinze@gcrmc.org, or Mary Jo Garst, RPh, pharmacist, at mgarst@gcrmc.org.

NMMRA offers additional information about health care-acquired infections and its work related to MRSA on its Web site at www.nmmra.org/providers/hospitals_mrsa.php, including a flyer that describes what MRSA is, who is at risk, how health care workers protect patients, and what patients can do to protect themselves (available at www.nmmra.org/resources/download.php?id=1837).

NMMRA is an Albuquerque-based, non-profit, physician-sponsored organization. Serving as a resource to the state's health care community and to Medicare beneficiaries, NMMRA seeks to fulfill its mission to facilitate demonstrable and continuous improvement in the quality of health care and achieve its vision to be a premier and innovative leader in improving health care. NMMRA has served continuously as the state's only federally contracted Medicare Quality Improvement Organization (QIO) since 1984. NMMRA also serves as the state's Medicaid External Quality Review Organization.

Gerald Champion Regional Medical Center (GCRMC) is the primary health care provider in Otero County and has been for over 50 years. The Medical Center is a 99-bed acute care facility located in Alamogordo, New Mexico. The current facility, with its award winning design opened in December 1999 resulting in continued growth over the past six years and subsequent expansions including a new intensive care unit, additional medical office building, and free-standing day care center. In 2005, GCRMC joined fewer than 5 percent of the hospitals across the country that had completed the Electronic Medical Record system. The medical staff of GCRMC has 154 medical members consisting of 70 active members, 54 affiliate members and 30 Allied Health members. GCRMC is the largest civilian employer in Alamogordo, employing over 600 people.