Antibiotic Stewardship For Physicians
Antimicrobial stewardship at Intermountain is committed to improving appropriate antimicrobial use system-wide, through coordinated interventions based on the Core Elements of Antibiotic Stewardship. Stewardship optimizes clinical outcomes while minimizing unintended consequences related to the use of antimicrobials. Intermountain offers providers resources to deliver the right antimicrobials, when patients need them.
Legacy
In 2018, Intermountain created a central position to direct antimicrobial stewardship efforts across the continuum of care after successfully implementing stewardship in small community hospitals. Intermountain had made earlier commitments to: ensure all Intermountain hospitals have antimicrobial stewardship programs that follow best practices; implement a hospital-based antimicrobial prescribing dashboard; and improve appropriate outpatient antimicrobial prescribing for respiratory conditions. At this time, the first two commitments have been completed with efforts underway to complete the third commitment. Antibiotic prescribing for outpatient respiratory encounters currently ranges from 15% to 97%, with Connect Care being one of the lowest prescribing clinics in the system. In addition to a prescribing data dashboard allowing providers to view this data, Intermountain has developed: tools for iCentra; education for caregivers and patients; and a public-facing media campaign. Intermountain leadership has demonstrated their full commitment to the development, implementation, and success of this initiative.
Our Care Process Models
Infectious diseases experts at Intermountain and the University of Utah have revised the Care Process Models for Strep Pharyngitis, Otitis Media, and Sinusitis with the most current information.
Strep pharyngitis:
Otitis Media:
Strong emphasis on watchful waiting/delayed prescriptions in mild/moderate Abx recommendations the same -Amox45 mg/kg/dose BID
Sinusitis
Watchful waiting/delayed prescriptions is the FIRST line therapy in BACTERIAL sinusitis
Amoxicillin still first line antibiotic recommendation for most
Peds amoxicillin dose increased to match otitis dosing
High dose amoxicillin removed
Adult and pediatrics CPM combined
- Care Process Model
- Adult Flash Card
- Pediatric Flash Card
- All CPMs can be found by clicking the link on your desktop or here
Community Acquired Pneumonia (CAP)
Urinary Tract Infection (UTI)
- Adult Care Process Model
- Adult Flash Card - Cystitis
- Adult Flash Card - Pyelo
- Pediatric Algorithm – 3 to 24 Months
- Pediatric Algorithm – 2 to 17 Years
- Pediatric Urine Culture Results Review
- Care Process Model FAQ
Skin and Soft Tissue Infections (SSTI)
New Tools and Techniques
In addition to updating our CPMs and Flash Cards, Intermountain has added new tools and techniques as part of our implementation of the Core Elements of Antibiotic Stewardship. For iCentra, we have created a Quick Visit that will help save time with charting diagnosis, charges, delayed prescriptions, patient education, follow-up, and even pre-populates a note. This is complemented by an alert that shows up whenever azithromycin is being prescribed outside of the recommended guidelines, which occurs 80-90% of the time in our system. We have also made delayed order sentences available in the system for amoxicillin and augmentin. More about these tools, including a reference guide on how to use them can be found in the handbook developed for providers.
Provider Updates, Tips, and FAQ
We have developed a watchful waiting and delayed antibiotic prescriptions fact sheet, through which patients will learn how to identify whether and when antibiotics are truly appropriate for their condition.
- Watchful waiting and delayed antibiotic prescriptions - English
- Watchful waiting and delayed antibiotic prescriptions - Spanish
Plus, providers can benefit from a new symptomatic therapies checklist, which is used to recommend treatments to relieve symptoms that bring discomfort to patients, without exposing them excessive treatment with antimicrobial agents.
Symptomatic Therapies Checklist
- Ages 0-12 English
- Ages 0-12 Spanish
- Ages 12+ English
- Ages 12+ Spanish
- All handouts can be found here
Prescribing data is available for all urgent care providers in the Intermountain system through our dashboard. Data is updated every month on the 2nd and can be reviewed for the previous month and as a rolling average at a glance. More detailed metrics can be reviewed in for each provider in the second “drilldown” tab.
Prescribing Dashboard
More resources can be found on the Pharmacy Antibiotic Stewardship Program page
Please e-mail scoreuc@imail.org with any non-urgent questions or feedback.
If you are a provider who would like clinical support from an infectious diseases physician, please call the SCORE hotline: (801) 507-2673