Antimicrobial Stewardship Program
The antimicrobial stewardship program (ASP) for the Memorial Healthcare System (MHS) functions to promote appropriate antimicrobial utilization. Our mission is to optimize antimicrobial use, reduce resistance rates, and decrease adverse events associated with antimicrobials. Our ASP comprises of physicians, pharmacists, nurses, microbiologists, and infection control preventionists whom all share a similar passion for providing safe and appropriate treatments for infectious diseases.
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 and Reporting
- Education
Memorial Healthcare System’s executive leaders support an active Antimicrobial/Antibiotic Stewardship Program (ASP) as an organizational priority. Antimicrobial stewardship is promoted across our diverse workplace through different committees.
The ASP Clinical Steering Committee is the overseeing body for ASP. MHS ASP Committee is the approving body for any ASP initiative. In addition, each facility 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 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.
Paula Eckardt, MD, FACP, FIDSA
Chief, Division of Infectious Diseases
Medical Director of Antimicrobial Stewardship Program
peckardt@mhs.net
Deborah Fernandez, PharmD, BCPS, BCIDP
Pharmacy Clinical Coordinator, Infectious Diseases
Memorial Hospital Pembroke
debfernandez@mhs.net
Lily Garcia, PharmD, BCPS, BCIDP
Pharmacy Clinical Coordinator, Infectious Diseases
Memorial Hospital West
esthgarcia@mhs.net
Juan Carlos Rodriguez, PharmD, BCPPS
Clinical Manager, Pharmacy
Joe DiMaggio Children’s Hospital
juarodriguez@mhs.net
Natasha Romero, PharmD, BCCCP, BCPS
Clinical Manager, Pharmacy
Memorial Regional Hospital South
naromero@mhs.net
Mina Abdalla, PharmD, BCPS, CPh
Pharmacy Clinical Coordinator and PGY1 Residency Program Director
Memorial Hospital Miramar
mabdalla@mhs.net
Eugene Kolomiyets, PharmD, MHA, BCPS, BCCCP
Pharmacy Clinical Coordinator, Infectious Diseases and Internal Medicine
Memorial Regional Hospital
ekolomiyets@mhs.net
Anthony O’Brien, PharmD, BCIDP
Clinical Specialist, Infectious Diseases
Memorial Regional Hospital
aobrien@mhs.net
Natalie Zilban, PharmD, MPH
Medication Safety and Pharmacy Officer
Memorial Healthcare System
nzilban@mhs.net
Sheila Montalvo, PharmD, BCPS, AAHIVP
Clinical Specialist, Ambulatory Pharmacist (ID/HIV)
Memorial Physician's Group - Division of Infectious Diseases
smontalvo@mhs.net
Eka Beriashvili, PharmD
Clinical Specialist, Ambulatory Pharmacist (ID/OPAT)
Memorial Physician’s Group - Division of Infectious Diseases
eberiashvili@mhs.net
Rachel Guran, MPH, BSN, RN, CIC, FAPIC
Director of Epidemiology and Infection Prevention
Memorial Healthcare System
rguran@mhs.net
Elizabeth M. George, MLS (ASCP)
Manager, Microbiology Department
Memorial Healthcare System
egeorge@mhs.net
Nancimae Miller, PhD, D(ABMM)
Technical Director - Microbiology and Molecular Infectious Diseases
Pathology Consultants of South Broward, LLC
nmiller@mhs.net
Learn About Our ASP Processes/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 antimicrobial, 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 collaborate with prescribers 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.
Our ASP team and Transplant Service collaborate on creating protocols for kidney, heart, and pancreas transplants, including pre-and post-transplant prophylaxis, vaccination, antimicrobial dosing for Extracorporeal Membrane Oxygenation (ECMO), driveline infection prophylaxis. We also work with our microbiology lab to create unit-level antibiograms for heart transplant recipients, including those with ventricular assist devices and on ECMO.
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, patients are provided with medication assistance and educational material through our Transition of Care services.
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 Infectious Disease Fellowship for physicians who want to specialize in infectious diseases.
Pharmacy Residency Program
Our one-year PGY2 Infectious Disease Pharmacy Residency Program trains pharmacists to become infectious disease pharmacists.
Infectious Diseases 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.
Clinic and Outpatient Infectious Disease
Memorial Physician’s Group-Division of Infectious Disease and Memorial Primary Care are committed to providing the highest quality of care from the management of simple infections to the most unusual of tropical diseases. Memorial provides the following comprehensive outpatient ASP and infectious services:
- Outpatient ID
- Ryan White HIV/AIDS Clinic
- Hepatitis Clinic
- Clinical Research
- Academic Fellowship
- Clostridium Difficile
- NTM/MAC Lung Disease
- MPOX Prevention and Treatment
- Tropical Medicine
- Immunizations/Vaccinations
- Transplant Infections
- OPAT/CoPAT in collaboration with Memorial Home Infusion
Memorial Employees/Pharmacists
Sign in to our intranet to access:
- Order sets
- Treatment guidelines
- Antimicrobial guidance book