Antimicrobial Stewardship Program
Memorial Healthcare System’s Antimicrobial Stewardship Program (ASP) promotes the appropriate utilization of antimicrobial medications. Our mission is to reduce antimicrobial resistance, decrease adverse effects associated with antibiotic use and increase the efficiency with which we care for our patients.
Our infection control and ASP activities are guided by the Centers for Disease Control and Prevention’s (CDC) Core Elements of Antimicrobial Stewardship:
- Hospital leadership commitment
- Accountability
- Pharmacy expertise
- Action tracking
- Reporting
- Education
Memorial’s executive leaders support an active Antimicrobial/Antibiotic Stewardship Program (ASP) as an organizational priority. We promote antimicrobial stewardship across our diverse workplace through committees.
Our ASP Leadership Steering Committee and ASP System Committee generate systemwide ideas and implement initiatives. Each Memorial hospital also has its own ASP committee that explores unique ASP opportunities for its site.
Appointed hospital leaders oversee their facility’s ASP work. Annually, each ASP identifies site-specific benchmarks and metrics to evaluate the effectiveness of their facility’s activity. The outcomes and subsequent reports offer insights about areas for our continued improvement.
We regularly review our performance on an individual facility and aggregate basis. This ongoing self-reflection enables us to continually evolve and expand our multidisciplinary participation to decrease antimicrobial resistance threats.
Meet Our Infection Prevention and ASP Team
Memorial’s ASP Leadership Steering Committee comprises physicians, pharmacists, nurses, microbiologists and infection preventionists. These professionals all share a passion for safe and appropriate infectious disease treatments.
Deborah Fernandez, PharmD, BCPS, BCIDP
Pharmacy Clinical Coordinator, Infectious Disease
Esther (Lily) Garcia
Infectious Diseases Clinical Pharmacy Coordinator
Memorial Hospital West
Juan Carlos Rodriguez, PharmD, BCPPS
Clinical Manager, Pharmacy
Natasha Romero, PharmD, BCCCP, BCPS
Clinical Manager, Pharmacy
Memorial Regional Hospital South
Natalie Zilban, PharmD, MPH
Medication Safety and Pharmacy Officer
Learn About Our Infection Prevention and ASP Processes and Protocols
Our pharmacists attend patient rounds in many of our facilities. Participating in rounds enables them to collaborate with the infectious disease team and make decisions for patient therapeutic management.
Along with site-specific initiatives, Memorial has adopted systemwide ASP processes and protocols designed to support our mission. They include:
We have guidelines for converting patients from IV to PO antibiotic therapy. If the patient meets certain criteria, our pharmacists can automatically make this change.
Memorial Healthcare System has developed vancomycin and aminoglycosides pharmacokinetic guidelines. This allows pharmacists to dose, order labs and adjust dosing based on drug levels and renal function. We monitor patients’ physiological responses to antimicrobial therapies.
Our electronic health record (EHR) provides alerts for target organisms, protected anti-microbial, bug drug mismatches and de-escalation. Pharmacists review these alerts on a daily basis and document the outcomes via interventions. If a patient taking an antibiotic has an antibiotic-resistant organism, we find ways to adjust and optimize their therapy.
Our protected antimicrobial formulary restricts the use of certain antibiotics. If a prescriber orders a medication on the restricted formulary, a pharmacist reviews the information to ensure it meets our pre-approved criteria.
Monitoring and Reporting
Memorial Healthcare System monitors and reports our ASP performance using various metrics and benchmarking tools, such as:
Our extensive annual ASP reports allow us to evaluate and trend our year-to-year performance. We measure antimicrobial use based on drug classifications and days of therapy.
We report our antimicrobial utilization data to CDC's National Healthcare Safety Network. Doing so enables us to benchmark our antimicrobial performance against similar facilities.
Memorial configures annual antibiograms for each facility. These profiles identify the top infectious disease organisms and their antimicrobial sensitivities and resistance. We trend and monitor bacterial resistance patterns to anti-infectives.
We measure our performance using additional metrics, including:
- Adverse drug events (ADE)
- Days of therapy per 1000 patient days present (DOT)
- Drug/unit cost expenditures (purchasing data)
- Hand hygiene compliance
- Hospital-acquired infections
- Multidrug-resistant organisms (MDROs)
- Order set utilization
- Rate of C. difficile infection
- Infectious Disease related pharmacy interventions including IV to PO, renal dose adjustments, de-escalations, etc.
Patient Education
When patients are admitted to our hospitals, our pharmacists review and reconcile their medications, often meeting with them in person. At discharge, all patients receive printed education materials about their medications. Memorial facilities also have a transition of care.
Antimicrobial Stewardship Training Programs
Memorial has two antimicrobial stewardship training programs: an Infectious Disease Fellowship and a Pharmacy Residency program.
Infectious Disease Fellowship
We offer a two-year fellowship for physicians who want to specialize in infectious diseases.
Pharmacy Residency Program
Our PGY2 Pharmacy Residency Program trains pharmacists to become infectious disease pharmacists. It is a one-year specialty program.
Infectious Disease Education
All Memorial employees and practitioners who order, dispense and administer antimicrobials are educated about our ASP practices upon hire and on an ongoing basis.
Our ASP committee distributes a quarterly systemwide infectious disease newsletter. These educational pieces offer up-to-date information on appropriate antimicrobial therapy for prescribers and pharmacy employees.
ASP Outpatient Services
Memorial Primary Care
- Retrospective review of orders prescribed from providers
- Assess prescriptions for therapy appropriateness
- Smart Set development and maintenance
- Academic detailing
- Pharyngitis review
Memorial Physician group – Infectious Disease
- HIV/AIDS Clinic
- Hepatitis Clinic
- NTM/MAC Lung Disease
- MPOX Prevention and Treatment
- Immunizations
- Transplant Infections
- OPAT in collaboration with Home Infusion
Community Pharmacy
- Outpatient vaccine administration
Memorial Employees/Pharmacists
Sign in to our intranet to access:
- Order sets
- Treatment guidelines
- Antimicrobial guidance book