1. Antimicrobial Stewardship Update- AzHHA Conference Call Re-Cap of Previous Conference Call: Why should we develop AMS Programs? What are some components of an AMS Program? Who should participate on your AMS Committee? Examples of Guidelines, Use of Data, Financial Information and PI Opportunities Examples of barriers for AMS programs

2. Recommended Components of an Antimicrobial Stewardship Program Foundation = 2 core, proactive strategies  Prospective audit with intervention and feedback  Formulary restriction and preauthorization Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 44 (1): 159-177, 2007. BEST PRACTICE

3. Financial analysis Antimicrobial expenditures: $6.3 million/year Conservative savings with appropriate utilization: 20% = $1.26 million per year Improve utilization by implementing antibiotic stewardship BEST PRACTICES; Needed resources: Pharmacist: $144,000/yr (salary/benefits) Physician Leader: $220,000/yr (salary/benefits) TOTAL = $364,000/yr (additional $ might be needed for IT support) Potential savings per year = $896,000 (ROI = 250%)

4. Next Steps 1.Re-evaluate physician leadership: ID physician group agrees to work with pharmacy on AMS program….($$) 2. Formulary evaluation: caspofungin vs. micafungin vs. anidulafungin 3. Transition from faculty ID pharmacist leadership to SHC pharmacy clinical staff: Shea pharmacy clinical coordinator to provide leadership (Dennis Snow, Pharm.D., BCPS) 4. Explore expansion of pharmacist clinical duties to include antimicrobial stewardship responsibilities: Involvement of clinical pharmacist specialists and residents 5. Add Pharmacist to Infection Prevention/Control Committee 6. Improvement of the 2 core proactive strategies

5. Antimicrobial Stewardship Closure Thoughts:  Need to continually evaluate organizational support for the program  Support of Hospitalists, Intensivists and Infectious Disease MDs is key  Clear, succinct data presentation creates value at all levels Questions?