A Collaborative Effort to Improve Antimicrobial Stewardship and Beyond

By Matt Phillion

Medication orders, clinical data, microbial sensitivities, and more—hospital pharmacies need all of this information, and many still rely on error-prone manual processes to gather and collate it. Pharmacies need a streamlined clinical and operational option to integrate data and deliver actionable analytics in one place rather than across disparate sources. This is particularly important in infection prevention and antimicrobial stewardship programs, where providers need to identify indications, treatment options, resistance considerations, potential drug interactions, and pharmacology.

Medical health device company BD has teamed up with Sanford Guide to help empower pharmacists to prioritize patient care and safety.

“We’ve been on this journey for a while,” says Brendon Hill, vice president of HealthSight Platform at BD. “Some of our customers’ biggest problems, medication safety and reducing medication errors, are systemic problems that can’t be solved by point solutions. There needs to be a systems approach, with connective tissue between products, analytics, and workflow tools.”

BD’s HealthSight™ Clinical Advisor is a pharmacy surveillance tool offering capabilities for both infection preventionists and clinical pharmacists. “It’s these pharmacists who are really on the front line of patient care, partnering with physicians at the bedside,” says Hill. “They make sure the medication therapy is really dialed in to what the patient needs, and not potentially causing adverse events.”

The tool can alert users to critical information that can influence a patient’s medication treatment. In addition to near real-time reporting, the tool allows reporting on groups of patients who are on important but high-risk medications. “For example, one very powerful antimicrobial is vancomycin,” says Hill. “If you’re not dialed in, it can cause kidney problems, so recent guidelines talk about having a much more quantitative approach to dosing this drug.”

Meanwhile, clinicians generally know what information they need, but it’s not built into their workflow. “If they have to hunt and peck, stitch the information they need together, things will fall through the cracks,” says Hill. “The cognitive load of these professionals is heavy. Healthcare technologies are constantly pumping new information out—how do we make it easier for them to synthesize it and bring it to bear in the moment?”

The HealthSight tool draws information from multiple sources—the electronic record, lab systems, and so on—and brings that information into an engine. The hospital sets up the rules, alerts, and alarms based on their practice of care so that notifications are meaningful.

Expertise in the moment

This is where Sanford Guide comes in: offering clinical insight and information that will help in clinical decision-making. Founded in 1969, Sanford Guide has been a trusted resource for clinicians on antimicrobial drugs and a range of infectious diseases, viruses, syndromes, and pathogens.

“There are a lot of places for clinicians to turn for good information. It’s often voluminous and takes a long time to process,” says Scott Kelly, senior vice president of Sanford Guide. “And most clinicians don’t have a lot of hours to sort through the information themselves.”

Sanford Guide follows the latest national and international guidelines, package inserts for drugs, published literature, and information released by professional societies, boiling it all down into clinically actionable recommendations. That information becomes available through the HealthSight Clinical Advisor tool.

“It might say, ‘Hey, you may want to consider the dosing on this patient with this drug, as there’s a conflict. Take a look at the patient record,’ ” says Kelly. “We’ve built a way for the clinicians to access the content from this platform so they don’t have to navigate elsewhere or go to another website. They can search the patient information as well as the drug information and have the latest clinical recommendations right there. This saves time, saves money, and improves patient outcomes.”

This information is provided at the point of care, which was always the goal for Sanford Guide, says Kelly.

“It’s a web-based tool, an operational tool in the moment,” says Hill. “The pharmacist has it up on a device, and [the tool] notifies them when there’s something new they need to know.”

Using vancomycin as an example, the drug’s renal side effects are a topic of discussion, and there are regulations around specific dosing calculations to ensure patients are receiving the drug at the appropriate rate. “With this tool, the clinical pharmacist might say, ‘I want to see every patient under my care on vancomycin,’ ” says Hill. “The patient details, lab results, all the guidelines, the algorithms from Sanford—it’s all integrated into one spot, which is a huge workflow benefit.”

“For us, the critical piece of this partnership is the credibility and rigor that Sanford Guide brings to curating this clinical knowledge,” says Hill. “It brings credible information to the clinician’s fingertips.”

Reactions from the field

Sanford Guide has been literally in the pocket of clinicians for decades, so clinicians trust the information. It’s just a matter of seeing the benefits of the new technology.

“For the clinicians, they don’t have to connect the data in front of them with the book or app in their pocket. The tool brings the information to bear and also highlights the key points so they’re not awash in data,” says Hill.

“A lot of systems are struggling to find a way to implement new recommendations and guidelines. It can be a big, daunting project, and this makes it easy,” says Kelly. “They’re struggling to overcome the hurdle of new dosing, and with this they can pull up the dosing calculator and it becomes an aha moment for them.”

Many hospitals have tried to calculate vancomycin dosing themselves using spreadsheets or the like, but this can be prone to error and difficult to understand and maintain, Kelly says—plus it’s not built into the clinical workflow.

“And it’s not validated,” says Kelly. “The nice thing about, for example, the vancomycin calculator is it offers the appropriate dose but also allows you to take that data and put it into the patient record. Not only do you have the result of the dosing calculation, but also a source—and anyone from The Joint Commission is going to recognize it as a reputable source—that you used the best available guidelines for the patient.”

The integration component, Kelly notes, offers accessibility, speed, and cost-effectiveness, but it also helps prevent and cut down on errors.

“Clinical pharmacists often work with the prescriber on how to adjust the dose. A lot of times an alert will be triggered and because our guidelines are actionable and concise, it cuts down on the time, effort, and opportunity for an error,” says Kelly.

Addressing an existential threat

The tool enables clinicians to search indications, treatment options, pharmacological interactions, resistance considerations, and more.

“Antimicrobial resistance is almost an existential threat to humanity,” says Hill. “Sanford Guide focuses on infectives, and the idea behind antimicrobial resistance is compelling. BD has invested a lot in public/private partnerships, really trying to drive antibiotic stewardship, a more appropriate approach and use of antimicrobials.”

There’s also a bit of a culture shift in how the industry looks at ROI. “In the past, we divided the world into hard savings and soft savings, like increased inefficiency and labor,” says Hill. “Just a few years ago, many hospital decision-makers would say [soft costs aren’t] real money, but the conversation has been shifting. These soft dollar costs are becoming the biggest problem, such as labor shortages among pharmacists and nurses.”
Another soft cost: the quality of life for employees, including how they work. “This goes back to putting the information in the workflow, in one spot, where it’s needed. This is transformational,” says Hill.

Just because the industry has digitized information doesn’t mean it’s all in one place and easy to parse. “Nurses are right at the front line, at the bedside. If the patient isn’t getting the most effective treatment, they’re dealing with the consequences in the moment,” says Hill. “Removing that physical and mental burden from the nurse can improve that quality of life.”

“Soft ROI is one of the challenges clinicians face every day,” says Kelly. “There are lots of resources out there, of varying quality, and it takes time to assess them: ‘Where is that morsel of information I need to treat my patient?’ And clinicians don’t have that much time to spend with the patient. The more time they get to spend with them on care, the more satisfied the physicians, the happier the patients.”

The combination of pharmacy surveillance and actionable guidelines offers improvement opportunities, and actions needed to move on those opportunities, adds Kelly. “There are different ways of approaching antimicrobial stewardship, but we share the same mission,” he says: “to ensure the right drug for the right bug in the right dose for the right amount of time.”

The collaboration also offers the chance to get better information out into the field faster. “It used to take months or years for clinical guidelines to move from research to implementation,” says Kelly. “One of the most exciting things about this collaboration is that Sanford is updating on a regular basis. Almost every day we push out a content update. We take the length of time between research and clinical intervention from years to months to weeks to days. If a new guideline is published today, there’s a pharmacist in the field using this tool who will be using it almost as soon as it’s published.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com