1. A ntimicrobial S tewardship P rogramme I nnovation R esearch E ducation S afety Development and Implementation of a “Reserved Antimicrobial Drugs” (RAD) Pre-Printed Order at the Vancouver General Hospital Tim T.Y. Lau, PharmD, FCSHP Pharmacy Lead, ASPIRES, Quality & Patient Safety, Vancouver Coastal Health Clinical Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia On behalf of the ASPIRES team Dr. Jennifer Grant, Dr. Titus Wong, Dr. Daljit Ghag, Felicia Laing, Salomeh Shajari February 2015 1

2. Conflict of Interest None to declare 2

3. Questions 1.What are Reserved Antimicrobial Drugs (RADs)? 2.How do we ensure RADs are prescribed appropriately? 3.What is the RAD pre-printed order (RAD PPO)? 4.What are challenges when developing and implementing a RAD PPO? 5.How do we evaluate a RAD program? 6.What are lessons learnt from the RAD program? 3

4. 1. What are Reserved Antimicrobial Drugs (RADs)? 4

5. Reserved Antimicrobial Drugs (RADs) Background –Since 2013, BC Health Authorities Pharmacy & Therapeutics (BCHA P&T) Committee developed criteria for target RADs –Rationale: Promote appropriate antibiotic use; Prevent emergence and spread of multi-drug resistant organisms 5

6. 2. How do we ensure RADs are prescribed appropriately? 6

7. RAD appropriateness No formalized process Clinical pharmacists –Target drug reports –Patient care rounds Restrictions –Infectious Diseases, Intensive Care Unit, or specialty physicians High utilization of RADs 7

8. 3. What is the RAD pre-printed order (RAD PPO)? 8

9. RAD PPO VCH Quality and Patient Safety, ASPIRES, and Pharmacy Facilitate prescribing of ceftAZIDime, daptomycin, linezolid PO/IV, meropenem (or formulary carbapenem), and tigecycline in accordance with provincial criteria; –Educate clinicians on restrictions; –Prompt clinicians to consider narrower spectrum agents; –Evaluate appropriate use of these agents Launched on Jan 26, 2015 at VGH 9

10. RAD PPO 10

11. 4. What are challenges when developing and implementing a RAD PPO? 11

12. Challenges Promotion of concept Stakeholder support –Heads of Medicine/Surgery –Medicine/Surgery –Pharmacy & Therapeutics & Medical Advisory Committees –VP Medicine Perception of increased workload –Prescribers, Pharmacy, Nursing, Nursing Unit Clerks 12

13. Challenges Development of policy –Workflow Prescriber, Pharmacy, Nursing Communication –Newsletter and memos Education –Pharmacy staff –Prescribers –Nursing Unit Clerks 13

14. 5. How do we evaluate a RAD program? 14

15. Evaluation Compliance Utilization Anti-infective consumption Staff and prescriber feedback 15

16. Evaluation Reserved Antimicrobial Drugs Pre-printed Orders Completed During Week 1, Jan 26 to Feb 2, 2015 New RAD Prescriptions RAD PPO completed RAD PPO sent to ward RAD PPO not sent 23 16 4 3 16 Reserved Antimicrobial Drugs Prescribed During Week 1, Jan 26 to Feb 2, 2015 Meropenem20 Linezolid2 Ceftazidime1 Daptomycin & Tigecycline0

17. 6. What are lessons learnt from the RAD program? 17

18. Lessons Learnt 1.Support from leadership –Meet with key opinion leaders 2.Stakeholder acceptance –Persevere –Engage stakeholders in development process 3.Simple to use –Complement workflow 18

19. What does this mean for patients? Think before prescribing Reduce unnecessary broad-spectrum agents Educate and support physicians at point of prescribing Review therapy on Day 3 –Narrow, IV to PO, discontinue Optimize patient outcomes Improve patient safety 19

20. Questions? Dr. Titus Wong Interim Medical Director, ASPIRES Email: Titus.Wong@vch.caTitus.Wong@vch.ca Dr. Tim Lau Pharmacy Lead, ASPIRES Email: Tim.Lau@vch.caTim.Lau@vch.ca Dr. Daljit Ghag Antimicrobial Stewardship Pharmacist, ASPIRES Email: Daljit.Ghag@vch.caDaljit.Ghag@vch.ca