Spotlight on Success: Sentara Medical Group Educates Patients, Families and Providers on the Fundamentals of Antibiotic Stewardship

June 27, 2019

Sentara Healthcare is a non-profit, integrated care delivery network providing services across Virginia and northeastern North Carolina. It is comprised of 12 acute care hospitals, four medical groups, advanced imaging centers, nursing and assisted living facilities, home health/hospice programs, and an integrated health insurance partner, Optima Health.

Sentara Medical Group’s (SMG’s) Antimicrobial Stewardship Program began in 2016 and is led by both a provider and pharmacists: Nancy Robbins, FNP-BC; Steve Sytsma, PharmD, BCPS – Clinical Pharmacy Specialist – Ambulatory Care; and Ashlee Hamel, PharmD, BCPS – System Coordinator, Pharmacy Clinical Programs. The medical group has an established Antimicrobial Stewardship Program that is integrated across all divisions and service lines. SMG partnered with Health Quality Innovators (HQI) in 2017 and enrolled 53 outpatient practice locations in the Combatting Antibiotic-Resistant Bacteria through Antibiotic Stewardship in Communities (CARB TASC) initiative as a way to elevate the program even further.

The initiative brings together emergency departments, physician practices, urgent care centers and other outpatient facilities to improve the use of antibiotics and protect patients from resistant infections by increasing the number of outpatient settings that have incorporated the Centers for Disease Control and Prevention’s (CDC) Core Elements of Outpatient Antibiotic Stewardship (Core Elements). These Core Elements include:

  1. Making a commitment to optimizing antibiotic prescribing and patient safety
  2. Implementing at least one policy or practice to improve antibiotic prescribing, assessing if it’s working and modifying as needed
  3. Monitoring antibiotic prescribing practices
  4. Educating clinicians and patients about antibiotic prescribing

Sentara was motivated to participate in this no-cost initiative with HQI because their leadership knew they would have the opportunity to educate patients, families and providers on the fundamentals of Antibiotic Stewardship and the risks of misuse/overuse of antibiotics, gain experience in assessing and determining which Core Elements were in place and/or needed in their facilities and acquire tools to assess their readiness for and implement an Antibiotic Stewardship Program.

When their work began with HQI, Sentara set a goal to involve all of their prescribing practices to help them understand the importance of being re-educated about antibiotic prescribing guidelines. “Our goals were to involve prescribing practices to get the message out on the importance of an Antibiotic Stewardship Program. We also wanted to reduce inappropriate prescribing of antibiotics for infections that don’t require this type of medication. This is especially true with viral infections,” said Nancy Robbins.

To engage prescribers and providers and to educate them about the Core Elements, Sentara held lunch and learn sessions, sharing best practices for prescribing antibiotics and treatment options that can be used when antibiotics aren’t appropriate. “The data for prescribing rates was very informative and made people more receptive to this program,” said Robbins. “After implementing the HQI CARB-TASC initiative, we measured claims data [to determine if there was a decrease in our antibiotic prescribing rates]. We were able to do a comparison of practices to see how each one compared within Sentara, as well as [review] blind data of other practices and statewide data.”

Through the Core Elements, Sentara is helping providers talk to patients about when antibiotics are and aren’t needed. For example, antibiotics will not help viral infections, so providers are offering patients materials about how to treat their symptoms using over-the-counter medications, fluids and rest. “We use a Safe Use of Antibiotics Poster in our exam room, provided to us by HQI, about antibiotics that is signed by providers stating that they are dedicated to better antibiotic prescribing practices,” said Ashlee Hamel. “This is a great way to show patients and families we are dedicated to practicing safe antibiotic use while still providing quality care.”

Results are still being collected, but so far, the data show a decrease in some practices’ antibiotic prescribing rates. Sentara is also seeing the impact their Antibiotic Stewardship Program has had on patients and families, who now have a better understanding of why they are or aren’t receiving a prescription for antibiotics. “We aren’t seeing as many patients demand to get an antibiotic,” said Robbins.

To build on their success, Sentara will continue to remind providers about the tools and tips they have learned through the CARB-TASC project and help providers keep the Antibiotic Stewardship Program top of mind. “We don’t want anyone to backslide into old prescribing habits. Providers see the positive outcome from implementing the program and we want them to continue to see results, all while providing the best care for our patients,” said Hamel.

“Having the extra support with HQI as a partner has been a positive experience. It has helped us look forward to other areas where we want to advance our medical group,” said Robbins.

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