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The Challenge of C. difficile and Antimicrobial-Resistant Gram-negative Infections:

Opportunities to Re-evaluate Current Management Approaches

A series of 10 live pharmacy workshops

About the Initiative

Throughout 2017 and 2018, a series of 10 live workshops were held at the annual meetings of State Societies of Health-System Pharmacists that was attended by approximately 1200 pharmacists. This application-based CPE activity provided a clinically-focused overview of the challenges associated with bacterial infections in the acute care setting, particularly antimicrobial-resistant Gram-negative infections and C. difficile infections. This program attempted to address the challenges clinical pharmacists face each day when managing patients with these serious infections and presented the latest evidence-based approaches in patient care.

Outcomes Analysis

This activity was designed to empower pharmacists with practical evidence-based knowledge on the management of serious bacterial infections so that they can apply this knowledge in their clinical practice. To assess the effectiveness of this activity, as well as identify continuing barriers and unmet needs, participants were requested to complete a post-activity survey that included competence-based questions with case study exercises. The survey also provided an opportunity to identify challenges and barriers pharmacists face in clinical practice. Participants were also able to describe how they intend to change their practice behavior based on participation in this activity.

Outcomes Results

Throughout the initiative, a total of 800 survey responses were completed and evaluated for this Outcomes Analysis. After evaluating the results of the competence-based post-test, the average score was 92% correct. Important findings from the survey are shown below.

Cumulative data from 10 State SHP Meetings Analysis of Survey of ~800 pharmacists across the US
Analysis # 1. *Pharmacists recognize a need to change practice behavior.*
Q. Please describe any changes you plan to implement based on participating in this activity.	4 out of every 5 pharmacists indicated that they plan to change their practice behavior based on this activity. The most common responses were: o Consult guideline recommendations more frequently o Evaluate patient risk factors for antimicrobial-resistant infection o Ensure adequate coverage of potential pathogens by the initial antimicrobial agent(s) o Consult local/hospital antibiogram o Utilize/promote use of rapid diagnostics o Assess patient for risk factors for recurrent CDI o Avoid use of metronidazole for CDI o Consider use of newer antimicrobial agents when appropriate
Analysis # 2. *Pharmacists recognize barriers to optimal patient management.*
Q. What are the barriers you anticipate that may impact implementation of these changes?	3 of every 4 respondents indicated specific barriers to making a change in practice behavior. The most common barriers identified were: o Lack of time and resources o Lack of qualified personnel o Difficulty changing hospital protocols o Resistance to change by peers/physicians o Formulary issues
*Analysis # 3. Pharmacist recognize there are still challenges with serious bacterial infections*
Q. What do you consider to be the biggest challenges in management of patient with serious bacterial infections?	9 of every 10 respondents were able to identify at least one challenge in the management of serious bacterial infections. The most common responses were: o Selecting an appropriate initial antimicrobial agent o Lack of rapid diagnostic tests to identify the causative pathogen o Preventing recurrent CDI o Treatment of the frail patient/patient with multiple comorbidities o Enforcing/adhering to infection control protocols o Lack of effective antimicrobials for resistant infections

Next Steps

Vemco MedEd and Center for Independent Healthcare Education would like to thank all who participated in this outcomes study who provided invaluable feedback on this activity as well as identified barriers/challenges based on personal experiences. The results from this analysis will be used to guide future educational programs that can specifically address the barriers and needs that have been identified.

We also welcome any additional comments. Please submit any comments or questions regarding the scientific program or outcomes study to: info@jointsponsor.com. We would be delighted to hear from you and to receive any suggestions for future educational programs.