WHAT: As a component of the Antibiotic Stewardship Program at Salem Hospital, starting Feb. 1, agents listed on the Anti-Infective Management Guideline (Salem Hospital restricted formulary) will undergo pharmacist’s review of selected ordering provider and/or indications for use during order verification. This applies to restricted orders for inpatients and emergency department patients.
WHY: Due to increases of multi-drug resistant organisms and carbapenem-resistant organisms (MDROs and CROs) seen in the community, the antimicrobial stewardship team determined it was pertinent to improve ordering processes and indications, which were utilized with the restricted formulary implemented in 2017. By improving ordering practices (and providing a thorough drug review) for selected agents we hope to improve patient care and outcomes, reduce microbial resistance over time, and decrease drug costs associated with restricted agents. In 2017, we selected ciprofloxacin as one of our efforts to focus on with the restricted formulary due to poor gram-negative susceptibility. In just three years we have seen a 10% increase in susceptibility to P. aeruginosa alone. This suggests that drug restrictions are an effective way to increase or preserve susceptibility in high use medications.
HOW: When a provider orders a restricted agent, the pharmacist will review ordering provider and indication selected for the medication. If an antimicrobial is not ordered by an ID provider or a provider does not choose one of the prelisted indications, the pharmacist verifying the order will notify provider. When giving feedback to the providers, pharmacists will be able to let the provider know what the correct ordering process is and provide indication suggestions or therapy alternatives if needed.
A tip sheet with screenshots for this process as well as the most updated version of our restricted formulary is available on the Pharmacy page located on the hospital intranet.
Please reach out with any question or concerns,
Danielle Britt, MA, PharmD — antimicrobial stewardship/infectious diseases pharmacist danielle.britt@salemhealth.org
Jasmin Chaudhary, MD — medical director infection prevention/infectious diseases section chief jchaudha@gmail.com