5/2/24 Check-in:

• Anthony Soto – new pharmacist at Syringa
• Reviewed April data report
  • Higher ASB prevalence, lower ASB treatment compared to cohort
    • Could focus on diagnostic stewardship
  • Inappropriate diagnosis of UTI trending down
  • Reduce Ciprofloxacin use
  • Reduce duration of abx
• At AMS meeting – discussed that there were many urinanalysis

6/20/24:

• Reviewed data report again
  • Tri-sulfa and nitrofurantoin should be in top 3 for oral UTI treatment
• Not listening to pharmacy on abx recs
• Discussed reducing duration
• Creating option for urinanalysis with no reflex

Facility 

• 10 patients/day
• Most physicians/nurses full-time, a few contract, 1 locum
  • 10 providers, some PAs, some doctors

• Alexsandra – IP, employee health nurse
  • only at facility 1/week
  • surveillance from home
  • running AMS program
• NP on team, outpatient pharmacist Audrey
  • NP presented to medstaff on ASB using slides
  • People open to change, listening
• Need a pharmacist
  • Having pharmacist talk makes big difference

AMS 

• Have been pulling reports
• One common issue – antibiotics are going max amount of time recommended
  • Some NPs and PAs have started to come down in duration
  • Most of the time correct antibiotics

ASB

• Plan to change cultures
  • Meeting next week to discuss
  • 2 options for ordering cultures (up to physician)
    • UA without reflex
    • UA with reflex
  • Previously, no one ordered cultures, now a lot of people order cultures
    • Some cultures in house, others send out
      • Urine done in house, blood sent out
    • Can check
• Reviewing cultures everyday

Data Collection 

• Have entered around 15 cases
• How are you choosing data?
  • have antibiotic prescribed, have culture, have UA
  • 3 UA that went to culture/day
  • To change – do not choose ones with antibiotic prescribed – randomly select cases
• Think about SMART goal