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Interprofessional Practice Based Research


Dr. Reem Haj, Dr. Clarence Chant and Dr. Elizabeth Leung

Name: Reem Haj, Elizabeth Leung

Role: Pharmacists

Project title: Optimizing antimicrobials: Using “CHART” data to identify patients eligible to be transitioned from intravenous to oral antimicrobial therapy

Fun trivia: This project has become part of a corporate objective!

Photo: Clinical Pharmacist Dr. Reem Haj (left), Director of Pharmacy Dr. Clarence Chant (middle), and Clinical Pharmacist Dr. Elizabeth Leung (right)

September 10, 2019

A tool to identify patients eligible to switch from IV to oral antibiotics

You are in the hospital because your small cut became badly infected and you need antibiotics - stat! In the past this likely would have meant an intravenous (IV) drip. Now there are a number of antibiotics that can be given in pill form. That’s right – no needle, no being tethered to a pole, and no being stuck in bed until someone can help you get the lines all sorted out. Add to that the benefit of reduced risk of line infection and often a shorter length of stay in the hospital.

In fact, for many antibiotics, the oral formulations are just as effective as the intravenous medications.

What’s the catch? Despite the fact that many oral formulations are equally effective to IV medication, IV antibiotics are still more commonly used in hospitals, and at times are over-prescribed. One of the biggest challenges facing clinicians in converting patients to oral medications is efficiently identifying patients who are ready to be converted, which can result in overuse of IV medications.  Historical practices of prescribing IV antibiotics and ingrained standard protocols contribute to the difficulty in shifting this practice. Furthermore, there are cases when there are good reasons for patients to remain on IV antibiotics. The key is to identify who should and who should not be on IV antibiotics.

Elizabeth Leung and Reem Haj, clinical pharmacists at St. Michael’s Hospital, are tackling this problem in a big way. Through a fellowship with IPBR and the Li Ka Shing Centre for Healthcare Analytics Research & Training (LKS-CHART), they are using big data to develop a computerized surveillance tool. The tool they are working on will sift through all of the patients in the hospital each day, identify those who are on specific IV antibiotics, and run information about their current medical status through an algorithm to determine who is and is not eligible for conversion from IV to oral antibiotics.

They are working together with a diverse team including physicians, pharmacists and a nutritionist, to ensure that the algorithm aligns with clinical judgement. By co-developing this tool, prescribing physicians will find it useful because they know they agree with the eligibility criteria the tool is using to identify these patients.

The tool to help identify patients that are eligible for conversion from IV to oral antibiotics has now been developed and is currently in its pilot implementation stage in the general medicine wards. The goal is to continue to roll out this initiative in the hospital and explore expanding the tool’s range to other IV medications which have appropriate oral options available.

Connecting with IPBR

The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Reem Haj and Elizabeth Leung are recipients of a CHART-IPBR fellowship. This fellowship provides mentorship, partnership with a data scientist, and funding for protected time to conduct the project. Elizabeth notes that “this fellowship has really allowed us to explore how big data can be used to support and inform system changes that improve patient care.”

Read more IPBR blog entries