Utilization of eICU Technology for Antimicrobial Stewardship Program

Background: Avoiding unnecessary antibiotic use and optimizing the selection and duration of antimicrobial agents improves patient outcomes while minimizing further antimicrobial pressure that generate resistance. Promoting antimicrobial stewardship is often a manual process requiring significant tedious time reviewing charts and laboratory data. Employing all available technology will allow the antimicrobial stewardship team to utilize time and energy more effectively.  Mercy Medical Center has an eICU that utilizes eCareManager™ (eCM) which provides a comprehensive dashboard view and drill down screens providing quick access to key clinical information enabling assessment and management functions.

Objective: The goal of this project is to form an antimicrobial stewardship team that will concurrently review antimicrobial therapy appropriateness for admitted patients in the medical ICU utilizing eCM. 

Methods: A prospective study was executed form April 2009 – Sept 2009 to evaluate the effectiveness of an antimicrobial stewardship team in the 17 bed adult medical intensive care unit at Mercy Medical Center.  The infectious disease pharmacist reviewed each patient Mon- Fri utilizing eCM each morning to identify interventions and then discussed cases with an infectious disease physician.  The unit’s ICU pharmacist continued to perform their standard interventions e.g., IV to PO and renal dosing adjustments during the study period. These interventions were not included in the analysis.  We measured antimicrobial use using defined daily dose (DDD) methodology.  The baseline mean DDD was calculated during the calendar year 2008.  The baseline number of antibiotic streamlining interventions from April – Sept 2008 was also determined.

Results: A total of 124 interventions were made during the study period.  Antimicrobial use of levofloxacin and vancomycin decreased by 23% and 11% respectively when compared to baseline data. The number of antibiotic streamlining interventions from April – Sept 2008 was 34, compared to 90 in the current study period.

Month	ADE Prevention	Antibiotic Streamlining	Clarify Order	Drug Information Consult	IV to PO Conversion	Add New Therapy	Renal Dosing
Apr	2	25	2	2		1
May	1	20	3	2		1	1
Jun		13			1		6
July		11			1
Aug		15		1		1	2
Sep	4	6					3
Totals	7	90	5	5	2	3	12

Conclusions: Utilizing eCM provided an electronic means of gathering patient specific clinical data to help aid in promoting antimicrobial stewardship in an ICU setting.  Although direct time savings was not measured, it was perceived that utilizing eCM was more efficient and was quicker than finding all the clinical information in the patient’s medical record.  The efficiency gained by utilizing new technology will allow the pharmacist more time for identifying inappropriate or suboptimal antimicrobial use and will allow the stewardship program to expand into the other adult critical care units within the hospital while performing nearly all of this work from one location.