Adventist Health Uses VigiLanz to Curb Infections
Adventist Health and Rideout, a nonprofit community-based health system in Marysville, California, provides services across the full spectrum of care, including general medical/surgery, intensive care, and cancer care. Comprised of an acute-care hospital and numerous medical centers, it is known for high quality and high patient satisfaction.
Hospitals across the country are experiencing high rates of hospital-acquired infections (HAIs). In fact, more than 800 health systems incurred reimbursement penalties from Medicare in 2019 because of too many HAIs, and one out of every 25 patients develops an infection while in hospitals, according to The Leapfrog Group.
Over the past few years, Adventist Health and Rideout has made reducing HAIs, particularly C. diff, a top priority. As a key part of this initiative, it has focused on reducing overprescribing of antibiotics, which is a common problem in hospitals, and which contributes to the rise in infections.
“We were struggling with overprescribing, with rates that exceeded the national average for similar hospitals of similar sizes,” explained Bryce Whitesides, PharmD, Pharmacy Operations Manager at Adventist Health and Rideout. “We were determined to improve our performance. We knew if we could improve, we’d see fewer infections.”
Before embarking on its initiative to curb HAIs, Adventist Health and Rideout was already using basic functions of VigiLanz’s platform to monitor patient care and fill in their EMR’s quality and reporting gaps. Still, Brock Taylor, PharmD, Clinical Manager at Adventist Health and Rideout, suspected the technology platform was underutilized.
“I spoke to our VigiLanz clinical support member who explained how we could use the technology to create more targeted and customized rules that would trigger alerts related to different types of data, such as prescribing data or lab data,” said Taylor. “The pharmacy team and infection prevention team then identified rules that we thought would be most helpful in monitoring and curbing infections.”
Now, pharmacists and physicians receive real-time alerts and if a red flag arises related to antibiotic prescribing—for example, if there is a mismatch between the medication ordered and the patient’s condition—pharmacists reach out to prescribing physicians to discuss the medication and determine if alternative approaches should be considered.
As part of the Adventist Health and Rideout approach, pharmacists contact physicians for discussions when they receive alerts related to antibiotic prescribing. Initially, some physicians resisted this approach, so an infectious disease specialist (rather than pharmacists) began to initiate the contact with ordering physicians. “Over time, as physicians realized they could trust the alerts, they were willing to comply with the pharmacists’ recommendations—which helped drive down the rate of inappropriate antibiotic prescriptions,” said Whitesides.
To further ensure appropriate antibiotic use, Adventist Health and Rideout’s infectious disease specialist and pharmacy clinical manager receive alerts if physicians prescribe an antibiotic that has restricted indications, such as ceftazidime/avibactam. Again, when this occurs, they work with prescribing physicians to ensure the prescription is appropriate.
“We developed these rules strategically so that pharmacists could provide clinical interventions more quickly if necessary,” explained Whitesides. “We’re making sure that we don’t contribute to the rise in infections in hospitals or in the community after patients are discharged.”
Adventist Health and Rideout also uses VigiLanz to help pharmacists and infection prevention team members determine if an infected patient acquired their infection in the hospital or in the community prior to or after the hospital visit. That’s because VigiLanz sends alerts as soon as lab data indicates a patient has an infection, such as C. diff. Since pharmacists and infection prevention team members are notified so quickly, it’s easier for them to determine the origin of the infection.
As the hospital has become better at identifying the origin, pharmacists and infectious disease team members have found that many of the infections they would have traditionally reported as HAIs actually originated in the community, said Whitesides. As a result, the hospital has improved its quality metrics related to HAIs.
“Before it was difficult to know if a C. diff infection was hospital or community acquired,” he said. “Now, we can show how our antibiotic optimization is working, and demonstrate that we’re helping to lower the community-acquired C. diff rates. We’re not sending patients home with unnecessary or prolonged antibiotic prescriptions.”
The continued focus on appropriate use of antibiotics, and on the de-escalation of antibiotic use when appropriate, has improved patient care at Adventist Health and Rideout. It has also led to significant cost savings.
C. diff. infections have fallen from several monthly to approximately one every other month, and use of Zosyn and other broad-spectrum antibiotics has declined significantly, said Whitesides.
The the hospital is now meeting national standards for antibiotic utilization, and annual antibiotic usage expenditures have fallen $500,000 per year.
“Our finances have steadily improved over the past five years. While a number of initiatives have contributed to that, VigiLanz has played a large role.”
– Bryce Whitesides, PharmD, Pharmacy Operations Manager
Recently, Adventist Health West System, a large integrated health system which owns Adventist Health and Rideout, decided to replicate Adventist Health and Rideout’s more optimized use of VigiLanz throughout all of its hospitals. Now, there are more than 20 medical centers on the West Coast and Hawaii using VigiLanz to support their efforts to curb HAIs and optimize antibiotic use.
“VigiLanz is a very powerful tool that we’ve used to make very significant interventions, not only in our patients lives but the hospital at large,” said Whitesides. “The impact continues to grow.”
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