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MediSys Health Network strengthens outpatient antibiotic stewardship

Promoting rigorous antibiotic stewardship is critical to reducing inappropriate antibiotic prescribing and selection. In 2017, MediSys Health Network developed a network-wide outpatient antibiotic stewardship program to monitor antibiotic use.

Initially, MediSys reviewed compliance with current national guidelines for appropriate management of streptococcal pharyngitis in its ambulatory clinics. Based on opportunities identified and the White House’s executive order on combating antibiotic-resistant bacteria, the network and ambulatory care leadership committed to developing an outpatient stewardship program to monitor antibiotic prescribing for acute respiratory illnesses.

The organization developed a three-pronged approach to improving antibiotic prescribing (provider education, patient education and electronic health record provider support). The goals were to decrease total antibiotic prescribing and inappropriate antibiotic prescribing across the network in a comparative pre- and post-implementation review. The organization found that provider education and feedback impacted inappropriate prescribing more than use of EHR hard stops.

Overall antibiotic prescriptions decreased 26.44% from the pre-implementation period (November 2014 to April 2015) to the post-implementation period (November 2017 to April 2018), and decreased 30.70% in comparing the pre-implementation and continuation period (May to October 2018) data. Inappropriate antibiotic prescriptions decreased 63.28% from pre- to post-implementation period and 62.16% from the pre-implementation to continuation period. During a recent four-month review, network-wide inappropriate antibiotic prescribing (pediatrics and adult) was 8.2%, which is well below the national average. Patient education tools, upper respiratory prescription pads and EHR provider support were implemented in all clinics throughout the network.

For more information, contact Luigi Tullo, MD, vice chair, ambulatory care, at ltullo@jhmc.org.