Providence VA Medical Center, Rhode Island
First VA Pharmacist Antimicrobial Stewardship Fellowship
Studies have shown that up to 50% of antibiotic use in hospitals is unnecessary or inappropriate. This improper use of antibiotics poses a critical threat to our ability to effectively treat infections. Unfortunately, antibiotic misuse—i.e. when antibiotics are given when they are not needed, are continued when they are no longer necessary, or are given as the wrong dose—leads to emergence and spread of resistant bacteria. Antimicrobial resistance is not a new problem. In fact, resistance developed soon after antibiotics first became widely used. Resistance has spread rapidly since then, however, and we are now threatened by “superbugs” that are resistant to all available antibiotics!
Antimicrobial resistance is associated with serious consequences, including the development of healthcare-acquired infections. Each year 1.7 million healthcare-acquired infections occur, including the potentially deadly infections Clostridium difficile (or C. Diff, a bacteria that attacks the intestines) and methicillin-resistant Staphylococcus aureus (or MRSA, a highly resistant bacteria that causes a variety of invasive infectious diseases throughout the body). Moreover, these infections are associated with billions of dollars in healthcare costs and tens of thousands deaths each year!
The response to the dangers associated with antibiotic misuse and overuse has been a clarion call to establish antimicrobial stewardship programs or ASPs throughout the country. Just what is an ASP? According to the CDC.gov get smart for healthcare campaign, ASPs “are interventions designed to ensure that hospitalized patients receive the right antibiotic, at the right dose, at the right time, and for the right duration.” The ultimate goal is to preserve the efficacy of antibiotics, decrease antibiotics resistance, and avoid the unintended consequences of inappropriate use.
The Providence VA Medical Center is on the forefront of meeting this challenge head on, having recently established an Antimicrobial Stewardship Program. “We’re the very first in the VA to establish an ASP pharmacy fellowship,” says Medical Center Director Vincent Ng, “and one of maybe two or three in the entire country.”
The ASP at the Providence VAMC is led by Dr. Kerry L. LaPlante, Pharm.D. Dr. LaPlante is Director of the Infectious Diseases Research Program and Infectious Diseases Pharmacotherapy Specialist at the Providence VAMC. She is also Associate Professor of Pharmacy with Tenure at the University of Rhode Island, College of Pharmacy, and Adjunct Clinical Associate Professor of Medicine at the Warren Alpert Medical School of Brown University. She is nationally-recognized for her work in the treatment, control, and prevention of MRSA, where she has authored more than 85 peer-reviewed journal articles, abstracts, and textbook chapters. Working closely with Medical Center leadership, Dr. LaPlante designed the ASP as a Post-Doctoral Clinical Research Outcomes Fellowship Program in Antimicrobial Stewardship.
“Dr. LaPlante has tirelessly spent approximately one year developing this fellowship program, which included a pilot study,” says Dr. Meg Gordon, Chief of Pharmacy at the Providence VAMC. “Our Facility Director, Vincent Ng, and our Chief of Staff, Dr. Gregory Gillette, supported our vision and recognized the clinical significance of antibiotic stewardship and approved first year funding of this two-year fellowship.”
All of Dr. LaPlante’s hard work finally paid off when, in July of this year, the Providence VAMC proudly announced the selection of Dr. Haley Morrill for the first-of-its-kind VA pharmacy fellowship.
Dr. Morrill, who graduated from the University of Connecticut School of Pharmacy in 2011, recently completed a post-graduate year one pharmacy practice residency at the Providence VAMC. Dr. Morrill’s goal is to become an independent pharmacy practitioner with a wealth of knowledge of the epidemiology and treatment of infectious diseases. In addition to maintaining up-to-date knowledge in infectious diseases pharmacotherapy and providing expert consultation, she will promote and develop the application of antimicrobial stewardship strategies to reinforce the ultimate goal of preserving the efficacy of antibiotics and decreasing antibiotics resistance at the Providence VAMC.
Although the program is still in its infancy, Dr. Morrill has hit the ground running. She has already begun daily audits of all inpatients prescribed antibiotics, which is roughly 30% of the Veterans admitted to the Providence VAMC. She reviews each patient’s chart, identifies potential antimicrobial misuse, and ensures the best “bug-drug” match. She also partners with clinicians to change the resistance patterns. “It’s a team effort,” says Dr. Morrill. She now regularly consults with a multi-disciplinary team of physicians, pharmacists, infectious disease specialists, and microbiologists to ensure we are using antibiotics appropriately—in other words, knowing the right dose, the right drug, and the right duration. Together, the team is thus fighting resistance and protecting our Veterans from the alarming consequences of superbugs.
The Providence VA Medical Center is glad to be on the cutting edge of a much needed initiative. “Antibiotic misuse is a community health threat,” says Dr. Gregory Gillette, Providence VAMC’s Chief of Staff. “We want to preserve the efficacy of the antibiotics we currently have. Establishing the first-of-its-kind VA fellowship targeting antibiotic misuse is a huge step in that direction.”
Ronald P. Jordan, R.Ph., FAPhA, Dean of the University of Rhode Island, College of Pharmacy, echoes this sentiment. “The goal of pharmaceutical research is to translate bench top basic research to actual bedside therapeutics that improve patient care. The VA is leading our State and nation in the establishment of this ASP fellowship, and we are certain its benefits to patients will bring additional pride and honor to our organizations.”
The Providence VAMC Antimicrobial Stewardship Program’s efforts in ensuring appropriate antimicrobial use today are helping in the fight against antibiotic resistance and the continued ability to effectively treat our Veterans in the future.