scholarly journals Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration

2018 ◽  
Vol 39 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Katie J. Suda ◽  
Daniel J. Livorsi ◽  
Michihiko Goto ◽  
Graeme N. Forrest ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Research Agenda ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

scholarly journals A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative

2017 ◽  
Vol 38 (5) ◽  
pp. 513-520 ◽  
Author(s):  
Allison A. Kelly ◽  
Makoto M. Jones ◽  
Kelly L. Echevarria ◽  
Stephen M. Kralovic ◽  
Matthew H. Samore ◽  
...  
Keyword(s):  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Antimicrobial Utilization ◽  
Before And After ◽  
Gram Negative Organisms ◽  
Proportional Distribution

OBJECTIVETo detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program.DESIGNObservational analysis.SETTINGThe VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities.METHODSUtilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities.RESULTSNationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection.CONCLUSIONSThe VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs.Infect Control Hosp Epidemiol 2017;38:513–520

scholarly journals Modified Veterans Health Administration Clostridioides difficile Infection (CDI) Prevention Bundle: Progress Over 8 Years Decreasing CDI Laboratory-Identified (LabID) Events at a Large Veterans Affairs Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s319-s319
Author(s):  
Patricia Byers ◽  
Andrew Hunter ◽  
Edward J. Young ◽  
Sherri-Lynne Almeida ◽  
Karen Stonecypher ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antimicrobial Stewardship ◽  
Veterans Health Administration ◽  
Team Approach ◽  
Veterans Health ◽  
Case Review ◽  
Health Administration ◽  
Care Providers ◽  
Core Measures ◽  
Community Onset

Background: In March 2012, the Veterans’ Health Administration (VHA) published the Guideline for the Prevention of Clostridium difficile infection (CDI) in VHA Inpatient Acute-Care Facilities, with a goal of 30% reduction of cases within 2 years. In March 2011, this facility, along with 31 others, served as a pilot site to develop the guidelines. Methods: The CDI prevention bundle was implemented to prevent new onset CDI cases in the facility with 4 core measures: (1) environmental cleaning (EMS), (2) hand hygiene, (3) contact precautions, and (4) cultural transformation. Education was provided to EMS staff, nursing, and care providers on the CDI case definition, criteria for testing, empiric isolation for patients with diarrhea, hand hygiene, and PPE to control spread. In 2014, antimicrobial stewardship was added, and within 5 years an algorithm for isolation and testing was published. Cases were reviewed weekly using TheraDoc software and were reported monthly to the national VHA Inpatient Evaluation Center (IPEC). Isolation was communicated using a ward roster/isolation list in TheraDoc for all unit champions to consult daily. CDI cases were classified using NHSN definitions for a laboratory-identified (LabID) event, recurrent cases, and community-onset cases. Real-time case review and weekly multidisciplinary case discussions identified opportunities for improved compliance with the core measures. Results: Over an 8-year period, CDI healthcare-onset LabID events decreased by 73%. The cases decreased from 149 to 40 over the 8-year period. The infection rate decreased 70% from 16.19 per 10,000 bed days of care in FY2011 (October 2010) to 4.88 in FY2019. The incidence of community onset infections increased from 75 in FY2011 to a high of 146 in FY2018 for a rate of 8.15 to 18.17. In FY2019, there was a decrease in both LabID events and community-onset cases to lows of 40 and 102, respectively. Inappropriate testing decreased by 84% from 50 in FY2011 to 8 in FY2019. Conclusions: A multidisciplinary team approach that included support from leadership and clinical providers as well as front line staff involvement, daily rounding, and case review by infection preventionists has reduced all CDI cases over an 8-year period using the modified VHA CDI bundle. TheraDoc enabled case review, correct isolation, changes to cleaning practices, and more appropriate lab testing. The antimicrobial stewardship program that includes clinical pharmacists working daily with providers was a strong driver for change.Funding: NoneDisclosures: None

Development and application of an objective staffing calculator for antimicrobial stewardship programs in the Veterans Health Administration

2017 ◽  
Vol 74 (21) ◽  
pp. 1785-1790 ◽  
Author(s):  
Kelly Echevarria ◽  
Julie Groppi ◽  
Allison A. Kelly ◽  
Anthony P. Morreale ◽  
Melinda M. Neuhauser ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

scholarly journals Setting the Research Agenda for Preventing Infections From Multidrug-Resistant Organisms in the Veterans Health Administration

2018 ◽  
Vol 39 (2) ◽  
pp. 186-188 ◽  
Author(s):  
Daniel J. Livorsi ◽  
Charlesnika T. Evans ◽  
Daniel J. Morgan ◽  
Heather S. Reisinger ◽  
Nasia Safdar ◽  
...  
Keyword(s):  
Research Agenda ◽  
Veterans Health Administration ◽  
Multidrug Resistant ◽  
Veterans Health ◽  
Health Administration ◽  
Multidrug Resistant Organisms

An Intervention With Meaning

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 376-383 ◽  
Author(s):  
Brooke A. Levandowski ◽  
Constance M. Cass ◽  
Stephanie N. Miller ◽  
Janet E. Kemp ◽  
Kenneth R. Conner
Keyword(s):  
High Risk ◽  
Qualitative Methodology ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Safety Planning ◽  
Health Administration ◽  
Suicide Method ◽  
Treatment Providers ◽  
Interactive Nature ◽  
Behavioral Health Treatment

Abstract. Background: The Veterans Health Administration (VHA) health-care system utilizes a multilevel suicide prevention intervention that features the use of standardized safety plans with veterans considered to be at high risk for suicide. Aims: Little is known about clinician perceptions on the value of safety planning with veterans at high risk for suicide. Method: Audio-recorded interviews with 29 VHA behavioral health treatment providers in a southeastern city were transcribed and analyzed using qualitative methodology. Results: Clinical providers consider safety planning feasible, acceptable, and valuable to veterans at high risk for suicide owing to the collaborative and interactive nature of the intervention. Providers identified the types of veterans who easily engaged in safety planning and those who may experience more difficulty with the process. Conclusion: Additional research with VHA providers in other locations and with veteran consumers is needed.

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