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15. AUP at the University of Central State Medical Center 169SummaryThe architects of the AUP tried to create a uniform standard with a nonuniformapproach. The AUP started off “on the wrong foot,” but after one year, the program isgaining acceptance. Despite all the questionable decisions concerning the design andimplementation of the program, data suggests that there is a trend toward betterpatient care. If planned carefully, any program alterations could provide a promisingfuture for the problems of antimicrobial utilization at the University of Central StateMedical Center. The potential for success is enormous.Exhibit 15.1. Summary of the Antimicrobial Surveillance Team:Costs, LOS, Mortality Rate—A Memo.To: University of Central State Health System Faculty and StaffFrom: Thomas A. O’Malley. M.D., Ph.D., Chief of StaffW. Michael Shultz, M.D:, Professor, Department of Internal Medicine, Division ofInfectious DiseasesLeigh G. Dell, M.D., Professor, Department of PediatricsDate: 02/15/99Re: Antimicrobial Utilization ProgramOn Monday, May 18, 1999, the University of Central State Health System AntimicrobialUtilization Program will begin. Under the direction of the antimicrobial utilizationsubcommittee of the pharmacy and therapeutics committee, the program willinvolve an ongoing review of a select group of inpatients receiving any of a target groupof high-risk, high-cost antimicrobials and those receiving three or more antimicrobialsconcurrently. Separate adult and pediatric antimicrobial surveillance teams (ASTs) willuse the hospital’s computerized information system to determine which patients willbe screened. An AST consisting of an infectious disease physician and a clinical pharmacyspecialist will round daily Monday through Friday and provide written recommendationsin the progress notes. After hours and on weekends, the assigned ASTphysicians will be on call for phone consultation.Ordering of category A agents (except continuation of antiretroviral therapy) willrequire prior approval by the physician on the appropriate adult or pediatric AST. Targetedcategory A agents may be ordered but will be placed on automatic stop order at72 hours unless prior approval is obtained. The remaining category A agents and allcategory C agents will be unrestricted. The AST on-call physicians will be available 24hours daily for consultation and to approve antimicrobial orders. Inpatient order entrycomputer screens are being updated to provide guidance on ordering and instructionsfor reaching the AST contacts. Policies relating to drug stop orders are being developedto ensure against inadvertent discontinuation of appropriate therapy.Collaboration among physicians, pharmacists, and nursing staff will be essential toensure that appropriate antimicrobial therapy continues without interruption and untilreview by the physician of record and the AST can be accomplished.Working together,we can succeed in meeting the program’s objectives of improved patient clinical outcomes,reduced microbial resistance, and more cost-effective prescribing.