Telehealth Antimicrobial Stewardship

Briefly describe your daily role as an antimicrobial stewardship pharmacist      

As an Infectious Diseases and Antimicrobial Stewardship Telehealth Pharmacist, I serve 18 small community hospitals across Utah and Idaho. Each day, I perform prospective audit-and-feedback through acknowledgement of targeted alerts, conduct interventions via telephone or instant messaging, answer questions from frontline pharmacists and providers, and remotely round with the ID Telehealth physician on patients with ID Telehealth consultations. When I have time after patient care, I focus on system and local stewardship projects, outreach antimicrobial stewardship activities, and clinical research. While most of my job is done remotely, our ID/AS Telehealth team sometimes travels to one of our hospitals or to a prospective outreach partner to meet with local clinicians. Unfortunately, the pandemic has put a hold on frequent site visits.

What telehealth stewardship initiative or antibiotic awareness effort are you most proud of that you have participated in or led?

In response to the COVID-19 pandemic, our telehealth program instituted Tele-COVID Rounds last year, which occurred daily via a video conference. Providers in our telehealth network presented COVID-19 patients and received feedback on management and therapeutics from an ID Telehealth physician and pharmacist duo. Empowering providers to care for COVID-19 patients through a teaching rounds model helped offload case load on our larger hospitals and educate on frequent updates for COVID-19 therapeutics recommendations. In addition to optimizing the pharmacologic management of COVID-19, we were able to intervene on unnecessary antibiotic. We noticed a significant decrease in early antibiotic use for pneumonia among COVID-19 patients following the implementation of Tele-COVID Rounds and a targeted stewardship alert (mean monthly DOT/1,000 COVID-19 patient days 657 pre- vs 240 post-intervention, p<0.001), accounting for an estimated 3,697 days of antibiotics avoided!

What does "Being Antibiotics Aware" mean to you?

“Being Antibiotics Aware” means understanding the principle of the right antibiotic (or lack thereof), at the right dose, for the right duration, in the right patient, and applying this important principle to every patient treated with antibiotics, every day. Vigilant use of antibiotics is crucial for ensuring patient safety and optimizing patient outcomes.

What is one pearl you have for all pharmacists to help them be antibiotic stewards?

Always ask yourself the question “Does this patient need antibiotics?”. I often get questions from frontline clinical pharmacists about switching antibiotics or antibiotic dosing for patients who don’t have a clear indication for antibiotics. These questions are some of my favorite. Don’t worry about that vancomycin dose for your patient with acute decompensated heart failure and “bilateral lower extremity cellulitis”. Here’s why I think it can be discontinued…  

Stephanie Shealy, PharmD, BCIDP

Infectious Disease and Antimicrobial Stewardship Telehealth Pharmacist

Intermountain Healthcare Community and Rural Hospitals