Caring for patients with varying levels of complexity during uncertain times is challenging for many clinicians. Pharmacists have been key players over the past two years as frontline workers, partnering with other care team members to solve medication-related issues as they continued the fight against COVID-19. Melanie Hyte, PharmD, serves as the Antimicrobial Stewardship Coordinator at Baptist Medical Center South, a licensed 492-bed, not-for-profit, faith-based acute care regional referral center. Baptist Medical Center South is fully accredited by the Joint Commission on Accreditation of Healthcare Organizations (TJC) and is a tertiary care center that is part of the Baptist Health network in Montgomery, Alabama.
Dr. Hyte describes how she and her staff of clinicians were successful in utilizing Sentri7 in the following ways:
- Enable early identification of COVID-19 patients throughout the health system
- Prepare for possible flexible staffing situations requiring offsite management of patients
- Improve the management of and provision for, needed pharmaceutical and biologic agents with minimal workflow interruption.
Sentri7 clinical surveillance aggregates Electronic Health Record (EHR) data to prioritize and provide real-time alerts to care teams, therefore improving clinical performance by placing the necessary tools and knowledge at their fingertips. By delivering earlier evidence-based interventions, hospital pharmacists are improving patient outcomes.
I recently discussed with Dr. Hyte how her team uses Sentri7 to maximize workflow efficiency by streamlining patient care and reducing disruptions as they are meeting and exceeding goals of continuous improvement with Antimicrobial Stewardship.
What were some of the key challenges your team faced at the start of the pandemic requiring you to leverage technology to maintain or improve your clinical workflow?
Initially, the largest barrier was the overwhelming uncertainty of the situation. The learning curve was steep and changed on a daily basis. We had to make quick decisions about how to identify, test, and treat patients in a time where there was no evidence-based standard for guidance. We quickly had to expand from a small area of only a few patients to a much larger group that covered several floors. The next phase of the process involved us beginning to think about staffing, in preparation for potential deficits, whether by shortage of pharmacists or overload of patients.
How did you use Sentri7 to prepare for the need to address possible staffing changes due to the pandemic?
Our goal was to be proactive and create a process to allow the pharmacists to work remotely with minimal disruption to patient care, should the need arise. The clinical pharmacy team routinely has a large consult workload of around one hundred consults per day. I reached out to the clinical and client services team at Sentri7 to help create a solution that would work for everyone. Our team utilizes a consult list and a microbiology report every day, so we quickly (in a matter of days) designed two alerts within Sentri7 that could deliver this data electronically within the Sentri7 dashboard, providing a paperless option should the pharmacists need to work remotely.
One of the other challenges we faced was the need to monitor patients in units that typically may have been outpatient areas. The influx of COVID-19 patients required us to pivot quickly to capture patients in areas that were either created or converted from outpatient to inpatient locations. We were able to be nimble and timely by leveraging the support of the Sentri7 team to make sure all patients were being captured in these new and converted locations.
What types of real-time alerts were you able to design related to testing and medication therapy using Sentri7?
We quickly created alerts to identify COVID-19 patients during the start of the pandemic when laboratory testing was highly variable. As testing continued to progress, we were able to use Sentri7 to update our surveillance of this population. In the beginning, we were cohorting positive patients in the same unit, so a negative test result allowed us to move a negative patient off of the COVID floor. This allowed our team to focus on these patients quickly, expediting care and/or partnership with Infection Prevention to share information regarding possible isolation.
As treatment regimens were implemented, Sentri7 constructed rules specific for the medications, which allowed the pharmacists to monitor those patients in a more efficient manner. In doing so, we continued to further separate patients according to COVID-19 status to help prioritize clinical workflow. From the start of the pandemic in March 2020, we have had nearly 8,000 interventions documented with COVID-19 rules, with a 99% acceptance rate on rule alerts.
Examples of alerts specifically related to pharmacotherapy include:
- Remdesivir surveillance
- COVID-19 patients requiring convalescent plasma
- Tocilizumab surveillance
- Hydroxychloroquine monitoring
- Bamlanivimab surveillance
- Casirivimab + Imdevimab surveillance
In the absence of this digital tool, how would you have gathered this data and pushed initiatives out to your staff?
It was a much more efficient process to monitor each medication, as opposed to using our electronic health record and pulling individual drug inquiry reports. Using COVID-19 testing information would have required us to collaborate with the laboratory, thus causing delays in receiving the necessary results and information. The rules and alerts that were available increased our efficiency tremendously. The support and clinical staff at Sentri7 used all resources at their disposal to help us with patient care.
Did you use the Sentri7 Analytics platform to help assess Antimicrobial Stewardship outcomes?
We use Sentri7 to submit Antimicrobial Usage (AU) data to National Healthcare Safety Network (NHSN). The Standardized Antimicrobial Administration Ratio (SAAR) value that is determined from this submission is present via Sentri7 Analytics. We used the SAAR value to show the relationship between “wax and wane” of COVID-19, and how that correlates with antimicrobial usage. For example, we were able to assess trends in antibiotic usage in the COVID-19 population, which allowed us to have conversations with prescribers about the actual prevalence of COVID-19 Pneumonia in this population. We could then study trends in Sentri7 Analytics reporting to see how we were able to impact prescribing habits.
During a time of uncertainty, patient care did not falter
The clinical team at Baptist Medical Center South Montgomery was able to improve clinical workflow, identify and manage opportunities for pharmacist intervention, and monitor and track outcomes by leveraging technology throughout the pandemic. During a time of uncertainty, they were able to act expeditiously with minimal disruption to patient care to ensure timely and safe administration of pharmacotherapy to patients.