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34 ANTIBIOTIC RESISTANCE & STEWARDSHIP 34 What Can Hospitals Do to Take a Stand Against Antibiotic Resistance? Inside the University of Chicago Medical Center's Stewardship Program By Max Green P icture a world where antibiotics don't work. at's the world Jen- nifer Pisano, MD, imagines and works to keep at bay every day. Recent media coverage has helped bolster visibility for the growing menace of antibiotic resistance, but Dr. Pisano, the medical director of the University of Chi- cago Medical Center's antibiotic steward- ship program, says she's been on red alert for some time now. "It's been an emergency for years," Dr. Pisano says. "Once it's been an emergency for so long, you get used to it. You have to get creative." In this role, Dr. Pisano oversees how the organization han- dles antibiotic prescription, drug management, drug shortages and education of both the public and University of Chicago's physician base on best antibiotic practices in the face of grow- ing bacterial resistance. e program comprises a dedicated physician and pharmacist team who specialize in infectious diseases and take a unique approach to stewardship, including active social media campaigning and data collection to provide physicians with feedback on their prescribing habits. And their efforts are paying off — University of Chicago Medical Center physicians adhere to the stewardship program's antibiotic prescription recommendations about 95 percent of the time. "We get called the antibiotic police sometimes, or people think we just want to put roadblocks in front of physicians and other providers who want to have autonomy with how they use antibiotics, but that's certainly not the case," Dr. Pisano says. "It's important to impress upon people there are a lot of misconceptions about antibiotic stewardship and the ultimate goal of any stewardship program is patient safety." Dr. Pisano spoke with Becker's about what hospitals can do to prevent the spread of resistance, how antibiotic steward- ship has changed in the last decade and using social media to educate patients. Note: Responses have been lightly edited for length and clarity. Question: Has the antibiotic stewardship program at University of Chicago Medical Center changed since anti- biotic resistance has become a more visible issue? Dr. Jennifer Pisano: Absolutely. We've been doing some kind of stewardship for over 10 years here but our program became official in 2010. e first couple years were really about drug restriction and education, about why it was important. It's kind of switched gears a little bit to a more quality and safety focus now. It's become easier in the past couple of years to get resources and buy-in from patients since there's been more talk about steward- ship. A few years ago, if a patient came in with a respiratory virus and you didn't want to give them an antibiotic, they would be hesitant. Now it's become easy to discuss why we are concerned about resistance and why we want to save antibiotics. We've seen improvement on the physician side as well; peo- ple are increasingly recognizing that it's important. We've been doing what we're doing for a while now and a lot of it depends on physician relationships and trust that our recommenda- tions are coming from a good place — not just cutting costs or restricting antibiotics, but a consideration for patient safety. Q: What are the main tenets of the antibiotic stew- ardship program? Have they remained the same since its inception? JP: e two kind of main tenets of stewardship are antibi- otic resistance and prospective audit and feedback. Before the program officially started, there was a prospective audit and feedback system in place where a designated person would monitor clinicians who were giving these restricted or protected antibiotics. eir cases would be followed and depending on what was going on with the patient, they'd see if we could nar- row the antibiotic or change it from the restricted agent and help the provider along in doing that. In 2010, we created a charter and got buy-in from adminis- tration for salary support for a physician and pharmacist pairing to kind of run the program. Since then, we've been building on the previous restriction and feedback and building out our program. We have a number of safety programs where we mon- itor blood culture results and give feedback to physicians to see whether the antibiotics they're using are appropriate, or if they can change them. We've continued adding on and growing the main tenets as we get more used to dealing with certain issues. Q: What has the clinician reaction been to having a team monitor their antibiotic prescriptions? JP: People know us by now and know what to expect on the other end of the line when they call us. I think accepting our recommendations involves building a relationship with us and knowing that we have the best intentions. Of course, patient safety is our number one goal. We do have times when physicians are steadfast in their approach and we have had to find ways to meet in the middle at times. In those instances, we reinforce the fact that everything