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Presented by : Vincent Nault PhD (c)

How to Win the War on Bugs: EHR with Automated Antimicrobial Prescription Surveillance System. Presented by : Vincent Nault PhD (c). Presenter Disclosure. Presenter: Vincent Nault Relationships with commercial interests: Shareholder of Lumed inc. Disclosure of Commercial Support.

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Presented by : Vincent Nault PhD (c)

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  1. How to Win the War on Bugs: EHR with Automated Antimicrobial Prescription Surveillance System. Presented by : Vincent Nault PhD(c)

  2. Presenter Disclosure • Presenter: Vincent Nault • Relationships with commercial interests: • Shareholder of Lumedinc.

  3. Disclosure of Commercial Support Potential for conflict(s) of interest: • Lumedinc. is the company licenced to develop and commercialize the product that will be discussed in this program: APSS. • Vincent Nault is also an employee of Lumedinc. and he is receiving a salary from the same company.

  4. Mitigating Potential Bias • Data used in this presentation was collected before the establishment of Lumed inc. • Data was produced and managed by the Centre Hospitalier Universitaire de Sherbrooke and the Université de Sherbrooke.

  5. Whyoptimizingantibiotics (Abx) ?

  6. Major Clinical and Health Concerns Negative impacts on patients’ health Toxicity Main risk factor of C. difficile Increased length of stay Inadequate spectrum coverage Increased Abx resistance Bacteria Abx Mutations Resistantbacteria

  7. It is costly 713-Bed Academic Hospital, 30 000 hospitalizations 1,7 M$/ year 50% inappropriate 10 000 hospitalisations 35 000 Abx prescriptions 210 000 doses

  8. Unanimous Recommendation Accreditation Canada Ministère Santé et Services sociaux Infectious Disease Society of America It is urgent to implementAbxstewardship

  9. Surveillance is Good… Admission Microbiology Laboratory Pharmacy EHR - Length of stay - Susceptibiliy profiles - Drug consumption - Intervention reports - Antimicrobials DDD - Filter : age, ward, time, etc.

  10. Computerized optimization is better

  11. Multistep Process Posology Interaction IV to PO Redundancy Cost Microbiology EHR Fluconazole + Statin Quinolones WBC normal To normal Pip-Tazo3g q6h CrCl < 20 ml/min Pip-Tazo + Metronidazole Unjustified use of meropenem Resistantbacteria

  12. Sequential Therapy 3 1 4+ 2 Ceftriaxone + moxifloxacin IV Amoxicillin PO Ceftriaxone IV Penicillin IV 3$ 0,25$ 3$ 28$

  13. The Right Choice, the Right Time Patient Lab ATM Micro Tx

  14. Impacts of APSS at the CHUS

  15. Types of Interventions (n=2733)

  16. Oral Abx Consumption PO DOT/1000PD PO Abx$/1000PD PO $ APSS APSS APSS Time-seriesanalysis; p<0.05

  17. IV Abx Consumption IV DOT/1000PD IV Abx$/1000PD IV $ APSS APSS APSS 22% of reduction in Abx IV consumption Time-seriesanalysis; p<0.05

  18. Overall Abx Consumption DOT/1000PD Abx$/1000PD $ APSS APSS APSS 13% of reduction in Abx consumption Time-seriesanalysis; p<0.05

  19. Direct Savings After 30 Months APSS Savings $922 000

  20. Questions ?

  21. Conclusion • APSS + EHR, a provensynergy • Reduction of 18 % in Abxexpenditures Reductionof 22 % in Abxconsumption IV • Intervention wassustainable and persistent

  22. Populations Proportion 65+ PD w/o Abx Proportion -2500 PD year PD w/ Abx

  23. Targeted ATM (n=2733)

  24. Impact of stewardship on CDI Valiquette et al. CID 2006.

  25. Return to baseline in 2 years -54% -43% -6% -22%

  26. Interventions From August 2010 to August 2012 61 654 prescriptions* 2733accepted (91%) 278 Physicianrefused 38718 no error 3011 22 936 2809 Pharmacistdisagreed 17 116 not reviewed 5820

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