抗生素PPT课件（英文精品）NEVADANS FOR ANTIBIOTIC .ppt

Pharmacist-directed pneumococcal vaccine protocol increases number of patients receiving immunization by 1200% MountainView Hospital - Las Vegas, Nevada Warren Wood, Pharm.D. Criteria checked by admitting nurse Over 65 Hx of COPD,CHF,CAP,Splenectomy, No previous vaccine If criteria is met, chart is stamped with an optional order for the physician to check off Once ordered, the patient was to receive the vaccine after consent was signed Started June 1999 Pneumococcal Vaccine Results after 3 Years# Patients Receiving During Hospitalization Federal Register Oct 2002CMS modified guidelines, Standing Orders Removed requirement for specific physician order Allowed Medical Staff Approved protocols, in place of specific orders Approved for Nursing Homes, Clinics, and Hospitals Pneumococcal Vaccine CriteriaCDC/MMWR 1997 All immunocompromised persons aged 2yr All persons over 5yr Persons age 2-64 with: Cardiovascular or pulmonary disease Diabetes mellitus Kidney disease Alcoholism, chronic liver disease Cerebrospinal fluid leaks Functional or anatomic asplenia Living in special environments or social settings Pneumococcal VaccineProcess Revision Proposed Protocol: Nurse assessment as before, list sent to pharmacy Move to a Pharmacist-Directed approach: Past success with IVtoPO conversion Change in Medicare Regulations Pharmacist will write order to administer Vaccine next day Physician and/or Patient has over-ride ability Pneumococcal Vaccine Results#Patients Receiving During Hospitalization Medicare National Voluntary Hospital Reporting Initiative4th Qtr MountainView was at 88% Urgent Care Antibiotic Use Eugene Somphone MD Urgent Care Department Chief Southwest Medical Associates Introduction Reduction of antibiotic use Initial assessment of antibiotic use Provider and patient education Incentives to reduce inappropriate use Follow-up studies Future reduction Urgent Care History SMA Urgent Cares 100,000 visits a year High volume of respiratory infections High