Minnesota Antibiotic Stewardship Acute Care and Critical Access Honor Roll

Application

Facilities may apply at any time. Updates to the Honor Roll will be made quarterly.

Step 1: Collect your information

• Download the Minnesota Antibiotic Stewardship Acute Care and Critical Access Honor Roll Application (PDF).
  Use this document as a guide to help you collect the information you need for your application.
  NOTE: This document is for your planning purposes only. This is not a fillable form, and is not intended to be turned in with your application.

Step 2: Fill out the application

• Fill out the Acute Care and Critical Access Hospital Honor Roll Application.
  This application mirrors the document from Step 1.
  NOTE: Applicants are now able to save and return to their application if they need to complete it at a later time.

Renewal Process

• Honor Roll membership will be renewable every two years. Renewal applications will be sent out two years after the initial online application was completed.
• Renewal applications contain the responses from the initial application. Those renewing will review the initial information for accuracy and add all renewal application information on the same form.
  NOTE: Applicants are now able to upload their letters of commitment and antibiotic stewardship policies directly into their application.

• Physician Leaders: Dan Anderson, MD and Steve Sonnesyn, MD
• Pharmacist Leaders: Emily Herstine, PharmD, BCPS, BCIDP and Delaney Hart, PharmD, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  Abbott Northwestern pharmacist review patients discharging on IV antibiotics for agent, monitoring, and line appropriateness.
• Collaboration:
  Abbott Northwestern’s stewardship program provides prospective audit and feedback, education on best practice, and coordination of pertinent stewardship data to some regional hospitals in the Allina system. The stewardship program also performs review of patients discharging on IV antibiotics for agent, monitoring, and line appropriateness across 5 hospitals. Outcomes of this work is currently being performed.

• Physician Leader: Stephen Davis, MD
• Pharmacist Leader: Michelle Hinojos, PharmD
• Highlighted Antibiotic Stewardship Activities:
  • Pharmacy AMS/ID consults for antibiotic decisions/recommendations and time-out considerations.
  • AMS Renal dosing protocol; Vancomycin Collaborative Practice dosing protocol; Aminoglycoside Collaborative Practice dosing protocol; Procalcitonin Collaborative Practice protocol.
  • AMS Pharmacy Team notes and multidisciplinary huddle discussions.
  • Express Lane/Smart Set (within EPIC) development for six clinics to guide treatment for different types of infections such as otitis media, UTI, pneumonia, pharyngitis, infectious diarrhea, etc.
  • MRSA nasal swab vancomycin de-escalation protocol.
  • Astera Infectious Disease Order Set creation containing most current treatment guidelines for most common infections.
• Collaboration:
  Astera works with colleagues in facilities such as nursing homes to mentor on antibiotic resistance, antimicrobial stewardship, and many other projects. Rose Lorentz, A-GNP, CWON, a member on the AMS Committee, provides care for nursing home patients as well as patients at local clinics. She is a leader for many antimicrobial stewardship efforts. Astera has shared order sets and protocols to help local outside facilities use best practice guidelines along with projects to reduce quinolone use in which they have seen decreases in C. difficile rates. Astera has also educated on antibiotic pharmacokinetic monitoring processes and protocols. In addition, they have worked with local retail pharmacies on providing patient assistance for patients unable to afford antibiotics and helped with care transitioning.

• Physician Leader: Eric Scrivner, MD
• Pharmacist Leader: Sara Elioff, PharmD, RPh, PIC
• Highlighted Antibiotic Stewardship Activity:
  Bigfork Valley Hospital has created an electronic medical record (EMR)-generated Prescriber Antibiotic Stewardship Performance Report that details patient, drug, frequency, stop/start dates, clinical indication, and ordering provider. This report is reviewed by the antibiotic stewardship program (ASP) and shared with prescribers as needed. It can be used to identify opportunities for improvement in prescribing practices.
  Bigfork Valley Hospital is also working to educate personnel on beta-lactam allergies in the setting of surgical prophylaxis. The goal is to create a pharmacy-driven ordering process, assess patient allergies early and thoroughly, and reduce patient exposure to broad spectrum antibiotics. 
• Collaboration:
  Bigfork Valley Hospital works closely with other rural Minnesota Critical Access Hospitals that are also serviced by their after-hours pharmacy provider. Together, this group of pharmacy leaders shares ASP initiatives utilized at each facility. Through this collaboration, initiatives may be adopted by some or all sites. For instance, the directly observed therapy (DOT) tracker developed by the pharmacy leader may be shared with other facilities.
  Additionally, pharmacists work closely with their Bigfork Valley long-term care (LTC) facility to provide recommendations for renal dose adjustments for antibiotic therapy. Bigfork Valley Hospital has a policy in place for renal dosage adjustments by pharmacists for LTC antibiotic orders. Additionally, they have invited the LTC infection preventionist team (Director of Nursing and Assistant Director of Nursing) to participate in ASP meetings. They are able to share antibiotic usage data tracked internally.
  The inpatient pharmacy continues to work closely with the on-site retail pharmacy to provide continuing antibiotic therapy upon discharge. This ensures appropriate therapy duration and reduction of antibiotic resistance. Additionally, the facility antibiogram is shared within the hospital, LTC facility, and local primary care clinic.

• Physician Leader: Christopher Anderson, MD
• Pharmacist Leader: Jennifer Klocker, PharmD
• Collaboration:
  CentraCare - Paynesville collaborates with other system wide regional critical access facilities and larger system wide hospitals to establish and participate in policies, protocols, and order sets for appropriate antibiotic use. CentraCare Paynesville has their own antibiogram which is available to all system level facilities via the intranet along with the CentraCare main campus antibiogram. This system wide collaboration has allowed CentraCare - Paynesville to increase access to resources such as remote consultations with infectious disease specialists.

• Physician Leader: Ulrika Wigert, MD
• Pharmacist Leader: Dennis Heinen, RPh
• Highlighted Antibiotic Stewardship Activity:
  The  CentraCare - Sauk Centre stewardship team utilizes prospective review of all intravenous (IV) antibiotics in all care setting. In addition, they use prophylaxis standardization for antibiotics, vancomycin kinetics, renal dosing protocols, and standardized order sets for Infectious Disease. 
• Collaboration:
  The CentraCare Health system collaborates in development of a regional antibiogram , uses shared order sets for infectious disease, has a system AMS committee, and has system renal dosing and surgical prophylaxis policies.

• Physician Leader: Nathan Harris, MD
• Pharmacist Leader: Jodi Behrens, PharmD
• Collaboration:
  CHI St. Joseph’s Health shares their antibiogram with all the area care facilities and clinics in the county and is the only healthcare facility in the county that generates an antibiogram. CHI St. Joseph’s accepts calls and questions about the antibiogram and/or antibiotic questions.

• Physician Leader: Bill Pomputius, MD
• Pharmacist Leader: Christina Koutsari, PharmD PhD BCPS BCIDP
• Collaboration:
  Ongoing collaboration between Children's Minnesota and Allina Health for the development and annual update of a pediatric guide for the treatment of common infections in children. The guide includes antibiotic selection, dosing, and duration recommendations. This guide aims to assist Allina Health prescribers when treating common infections in pediatric patients.

• Physician Leader: Laura Fier, MD
• Pharmacist Leader: Justin Richards, PharmD
• Collaboration:
  Cuyuna Regional Medical Center has an ongoing antimicrobial stewardship collaborative that actively works on optimizing antibiotic stewardship during transitions of care.

• Physician Leaders: Sreejith Gopi, MD
• Pharmacist Leader: Stephanie Nixon, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Essentia Health Ada is part of a larger health care system that collaborates to review antibiotic usage and susceptibilities among all our patients. This allows patients to stay local and not travel so far to receive the same great medical care.
• Collaboration:
  Essentia Health Ada neighbors the local long-term care facility and assisted living apartments. The residents feel a sense of structure and trust by having the same providers care for them at the facilities and in the clinic/ED/hospital here.

• Physician Leader: Jared Lund, MD
• Pharmacist Leader: Hannah Athman, PharmD, RPh
• Highlighted Antibiotic Stewardship Activity:
  At Essentia Health Deer River, antimicrobial use is monitored by using data from the electronic medical record to analyze trends in the usage of these medications. Special attention is paid to the top ten most frequently prescribed agents to ensure appropriate use. Data are also used to evaluate prescribing trends within a department or by individual prescriber, inform agent-specific initiatives within the facility, and to identify and address prescribing within the facility, a department, or discipline which needs optimization.
• Collaboration:
  • Retrospective chart review is completed quarterly per contracted services with Lakewood Surgery Center to ensure appropriate perioperative antibiotics are used. 
  • Infectious culture and sensitivity results for patients transferred outside of the Essentia Health system are communicated to the receiving facility to ensure timely access to laboratory results affecting antimicrobial use. 
  • Essentia Health Deer River accepts patients to swing beds to complete IV antimicrobials per infectious disease recommendations. Patients continue to be evaluated by infectious disease via tele-services per provider discretion. Prior to the admission of these patients, electronic medical records are reviewed to ensure the patient is appropriate for the facility and requested medications and/or services can be provided.

• Physician Leader: Gratia Pitcher, MD
• Pharmacist Leader: Megyn Albrecht, PharmD
• Collaboration:
  Essentia Health – Duluth engages in formal mentorship of area hospitals, long-term care facilities, or clinics where expertise is shared in a structured, ongoing partnership. Regional coordination of data, protocols, or best practices (e.g., sharing antibiotic use and resistance data with other facilities in a benchmarking process) and using regularly scheduled meetings to facilitate information exchange. Actively optimizing antibiotic stewardship during care transitions through regular meetings among facilities that share patients, and development or improvement of protocols and communication practices.

• Physician Leader: Cheryl White, MD
• Pharmacist Leader: Ryan Laposky, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Essentia Health (EH) Fosston is composed of a multidisciplinary antimicrobial stewardship team of pharmacists, physicians, physician assistants, nurse practitioners, and nurses that meet daily to review appropriate antimicrobial use within the hospital to ensure optimal culture-guided treatment. EH Fosston also utilizes pharmacy-driven antibiotic stewardship interventions and uses days of therapy data to evaluate overall prescribing trends through the electronic medical record.
• Collaboration:
  • Collaboration with Northwest Health Services Coalition on COVID-19 therapeutics.
  • Antibiograms shared at local P&T which includes representatives from long-term care, clinics, home health, hospice, assisted living.
  • Pharmacy involvement in transitions of care to review antibiotic regimens at patient discharge to home, assisted living, or nursing home.

• Physician Leader: Jay Schmidt, MD
• Pharmacist Leader: Kassandra Grimes, PharmD
• Collaboration:
  Through collaboration with their long-term care facility, Essentia Health Graceville/Holy Trinity Hospital implemented the 48-hour timeout, also with every antibiotic prescribed requiring diagnosis and culture review.

• Physician Leader: Thomas Witt, MD
• Pharmacist Leader: Stephanie Nixon, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Essentia Health Moose Lake uses days of therapy data to evaluate overall prescribing trends, inform agent-specific initiatives, and identify and address outlying prescribing within a prescribing location or discipline. On-site pharmacists provide discharge education in the acute care setting for those being discharged on antibiotics.
• Collaboration:
  The antibiotic stewardship program manager attends quarterly medical staff meetings to speak on antibiotic stewardship efforts throughout the facility with prescribers, including both Essentia and non-Essentia providers invited from non-affiliated clinics. Essential Health Moose Lake shares information and antibiotic medications with other non-Essentia local hospitals and clinics to help with cost savings and antibiotic stewardship efforts.

• Physician Leader: Christopher Whiting, MD
• Pharmacist Leader: Peter Mattson, RPh
• Highlighted Antibiotic Stewardship Activity:
  Essentia Health – Northern Pines obtains methicillin-resistant Staphylococcus aureus (MRSA) nares swab with all intravenous (IV) vancomycin orders. This screens for early de-escalation of vancomycin for empiric treatment in indications beyond just pneumonia, including, skin and soft tissue infections, intraabdominal infections, diabetic foot infections, and urinary tract infections.
• Collaboration:
  Essentia Health – Northern Pines collaborates with the attached long-term care facility on antibiotic stewardship best practices when providing clinical patient care to residents. 

• Physician Leader: Thomas Witt, MD
• Pharmacist Leader: Gina Roth, PharmD
• Collaboration:
  Essentia Health Sandstone (EHS) performs ED culture reviews and notifies providers outside of EHS of cxs and sensitivities when they are transferred out. They follow up with patients and provide counseling regarding appropriate use and medication optimization. This may often times require communication with providers outside of the system or local pharmacies as well to adjust therapy or support transitions of care.

• Physician Leader: Christa Eickhoff, MD
• Pharmacist Leader: Sarah Patton, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Essentia Health - St. Joseph’s Medical Center is participating in an initiative to decrease carbapenem prescribing rates at the hospital. The pharmacy residency team has collaborated with the physician leader to provider an AMS rotation and learning experiences for residents. The pharmacy team has also been working with a physician-led group to evaluate hospital-acquired C. difficile reduction.
• Collaboration:
  Most recently, Essentia Health - St. Joseph’s Medical Center collaboration with other facilities and institutions have primarily revolved around COVID-19 therapeutics and resources. This previously included sharing their supply of Anti-SARS-CoV-2 monoclonal antibody agents (mAbs) and COVID-19 vaccine with surrounding sites, including independent retail pharmacies. In addition, the pharmacy team consults with an independent surgery center in town and have collaborated by sharing our antibiogram and discussing use of appropriate pre-op antibiotics in those with a penicillin allergy. 

• Physician Leader: Ritesh Singh, MD
• Pharmacist Leader: Kayla Ruppert, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Essentia Health Saint Mary's - Detroit Lakes utilizes pharmacy-driven antibiotic stewardship interventions, including formulary restrictions, guidelines for IV to oral conversion, and prospective audit with feedback. Clinical pharmacists review patients daily to ensure appropriateness of antibiotic therapies based on an antimicrobial stewardship "score" assigned by the electronic medical record (EMR). This review includes an assessment of prescribed antibiotics, duration of therapy, culture results, and opportunities for de-escalation. Findings are documented in the EMR and providers are contacted as needed for follow up.
• Collaboration:
  Essentia Health St. Mary's - Detroit Lakes provides support for clinicians out of regional clinic and critical access sites on request including answering questions for initial treatment, treatment of patients with numerous antimicrobial allergies, and aiding with culture-guided treatment. Consult requests may come from providers or inpatient, clinic, or outpatient pharmacists. The St. Mary's team also provides antibiogram information to area nursing homes and others upon request and helps with the distribution of COVID-19 vaccine and other vaccines to regional clinics.

• Physician Leader: Gratia Pitcher, MD
• Pharmacist Leader: Julia Sybrant, PharmD, MPH
• Highlighted Antibiotic Stewardship Activity:
  The Essentia Health Saint Mary's Medical Center (EH-SMMC) antimicrobial stewardship team combines a blend of pharmacists, physicians, nursing and quality partners to ensure the safe and effective use of antimicrobial therapy for our patients. Annually educating all hospital staff on antimicrobial stewardship. We aim to reduce hospital acquired infections and streamline antimicrobial therapy efficiently. The EH-SMMC staff strive to be collaborative with other institutions to ensure seamless transitions for our patients on antimicrobial therapy.
• Collaboration:
  • St. Mary's Medical Center (SMMC) works closely with Essentia Health Duluth Hospital and Essentia Health St. Mary's Hospital of Superior during patient transitions for continued care. SMMC also works with an outside facility, Option Care, when patients are discharging and continuing on antimicrobials that require further monitoring. Information is shared with Option Care, including organism, susceptibilities, previous treatment and pharmacokinetic levels, and current duration plan. 
  • Within the Emergency Department, SMMC also has a partnership that allows dispensing of prophylactic medications to patients at discharge following a Sexual Assault Nurse Examination (SANE) that is the most up to date recommendations following potential exposure. The ED Pharmacist also participates in culture review of patients previously seen in the ED with positive culture results post discharge to ensure patients are getting antimicrobial therapy that need it, correct medication for culture results and discontinuation or de-escalation of therapy if appropriate. This process was extended out to other Essentia Health sites this past year with training from our ED personnel. 
  • SMMC submits antimicrobial usage and resistance data to the National Healthcare Safety Network (NHSN) monthly along with participation in meetings to review the results and benchmark with other institutions that collaborate with NHSN. SMMC also participates in a market level AMS review committee that meets monthly to review items such various HAIs: CAUTI, CLABSI, HAP/VAP, and Sepsis Alerts. The team will review cases and resistance patterns.

• Physician Leader: Malati Pemmaraju, MD
• Pharmacist Leader: Tara Parks, PharmD
• Collaboration:
  Virginia pharmacists provide post-ED visit culture review and follow up with patients to ensure they are on the appropriate antibiotics for cultures/sensitivities that result after patients have left the ED. Pharmacists will provide new orders to pharmacies and counsel patients on new medications as necessary. If patients are transferred from this facility to another facility outside of Essentia Health, pharmacy contacts the transferring hospital pharmacy with culture and sensitivity data for mutual patient care continuation. Virginia Pharmacy will provide guidance for our urgent care providers on antibiotic selection for outpatients.

• Physician Leader: Ketzela Marsh, MD
• Pharmacist Leader: Paul Jensen, PharmD, BCPPS
• Highlighted Antibiotic Stewardship Activity:
  Multidisciplinary rounds are held every Monday, Wednesday, and Friday to review all patients receiving systemic antimicrobials for purposes other than surgical prophylaxis. The antimicrobial stewardship committee at Gillette Children's Specialty Hospital includes an education specialist. In addition to provider education, the hospital provides information about antibiotic use and resistance to patients and families.
• Collaboration:
  Since mid-2022, Gillette Children's Specialty Hospital has collaborated with the antimicrobial stewardship program at Children's Minnesota to revise surgical antibiotic prophylaxis guidelines. Knowing that the hospitals share some of the same patients as well as surgical/OR clinicians, having a more consistent approach to surgical prophylaxis would ensure appropriate use for all patients and streamline practices for staff.

• Physician Leader: Simon Lick, MD
• Pharmacist Leader: Tyler Waller, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Grand Itasca has worked hard to collaborate with local skilled nursing facility partners in the community. They provide partners with copies of the antibiogram and have member representation on the Antibiotic Stewardship Committee.
• Collaboration:
  Grand Itasca works with local skilled nursing facilities to develop a tool to prevent the over-prescribing of antibiotics for confusion and assumed urinary tract infection. The partnership with those members and their feedback towards the ER and Clinic has been tremendously helpful and helps Grand Itasca identify providers and departments to offer added education to.

• Physician Leader: R. Bryan Rock, MD
• Pharmacist Leader: Aileen Ahiskali, PharmD, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  A new initiative Hennepin County Medical Center (HCMC) plans to roll out this year is disease-state driven prospective audit and feedback – this will enable HCMC to track clinical outcomes more easily as opposed to just antibiotic use.
• Collaboration:
  Healthcare for the Homeless – the ASP pharmacist serves as the point of contact for infectious diseases and antibiotic-related questions. Many patients do not want to go to the hospital, and thus this collaborative relationship provides antibiotic expertise to high risk patients. Additionally, the stewardship pharmacist is a member of the Minnesota One Health Antibiotic Stewardship Collaborative in which she contributes to discussions at meetings with ID specialists from around the state.

• Physician Leader: Adrianne Moen, MD, FFAAFP 
• Pharmacist Leader: Amanda Hemmila, PharmD
• Highlighted Antibiotic Stewardship Activity:
  The Clinical Pharmacy team at Lakewood Health System (LHS) is responsible for completing a thorough review of prescribed antibiotic therapy. This process begins at initiation of treatment and again at 48 hours. Pharmacy recommendations regarding appropriate choice of antibiotic therapy, dosing frequency, treatment duration, de-escalation of therapy, IV-to-oral interchange, and other pertinent clinical information is discussed daily with providers at the interdisciplinary team meeting. The process facilitates care coordination required for planned outpatient parenteral antibiotic therapy and has led to a decrease in broad-spectrum antibiotic use within the system. The process also allows for prompt education on current guidelines and recommendations for treatment of common infections.
• Collaboration:
  Lakewood Health System (LHS) Care Center is an active participant in the hospital antimicrobial stewardship committee. Resistance issues and prescribing practices at the care center are regularly discussed during quarterly meetings. The care center representative is involved in the development of antibiotic stewardship education distributed to all LHS employees. Antibiotic stewardship knowledge is constantly exchanged through this established partnership.

• Physician Leader: Alan Grillo, MD
• Pharmacist Leader: David Simmons, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Antimicrobial Stewardship is an organizational priority through support of our Antimicrobial Stewardship Policy. LifeCare Medical Center’s core elements include leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. LifeCare Medical is dedicated to improving antibiotic prescribing practices and optimizing the treatment of infections while reducing adverse events associated with inappropriate antibiotic use. Pharmacists provide clinical reviews of prescribed antibiotics, including take home antibiotics from the emergency department.
• Collaboration:
  The Antimicrobial Stewardship Program at LifeCare Medical Center has worked closely with retail pharmacies, public health, and clinics to establish proper antivirals for patients in the community during the COVID-19 pandemic. LifeCare Medical Center's antibiogram is shared with local pharmacies, clinic providers, along with LifeCare Medical Center's long-term care facilities. Regionally, the antimicrobial data from LifeCare is shared with Altru Health in Grand Forks, ND. The providers in our clinics and long-term care facilities are part of LifeCare Medical Center's staff and receive education at medical staff meetings. Pharmacists and providers collaborate with long-term care and assisted living facilities to help manage and treat COVID outbreaks. Protocols and policy updates are established and reviewed at monthly antibiotic stewardship meetings as needed. Pharmacists review intravenous antibiotic therapy for subacute and long-term care patients.

• Physician Leader: Edwin Pereira, MD
• Pharmacist Leader: Laurel Thomas, PharmD, BCPS
• Highlighted Antibiotic Stewardship Activity:
  M Health Fairview Bethesda Hospital utilizes Bayesian area under the curve methodology for dosing and monitoring vancomycin. This best practice was implemented in 2021, and evaluation of clinical outcomes associated with this change in practice is underway overall and for several special populations (e.g., patients on continuous renal replacement therapy and CNS infections) where data are lacking to inform practices.
• Collaboration:
  M Health Fairview Bethesda Hospital participates in the Minnesota Department of Health NHSN AU Option User Group which meets quarterly to discuss trends in antimicrobial use and facilitate information exchange between health systems in Minnesota.

• Physician Leader: Aditya Chandorkar, MBBS
• Pharmacist Leader: Jennifer Ross, PharmD, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  Lakes Medical Center is one of two tele-antimicrobial stewardship sites within M Health Fairview. In 2022, Lakes led the way in rolling out a system-wide skin and soft tissue infection guideline through collaboration with a Lakes ED provider. This guideline provides empiric therapy antibiotic recommendations for cellulitis (non-purulent and purulent), abscess, and management recommendations (e.g., incision and drainage, non-infectious considerations, etc.).
• Collaboration:
  Lakes shared their skin and soft tissue antibiotic prescribing practices with sites across the system. This data helped guide creation of a system-wide skin and soft tissue guideline. They are waiting for an adequate amount of time to pass to thoroughly review post-implementation impact. This project has served as a platform for meeting The Joint Commission (TJC) revised elements of performance in reviewing antibiotic appropriateness for a given disease state for the health system acute care sites as well as future collaborative efforts with ED providers and hospitalists.

• Physician Leader: Laura Norton, MD, MS
• Pharmacist Leader: Meredith Oliver, PharmD, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  The pediatric antimicrobial stewardship team uses prospective audit with feedback to prescribers and incorporates handshake stewardship into their daily rounding. The team also partners with providers to create local clinical practice guidance to optimize antimicrobial use. An example of the success of this collaboration was a substantial decrease in broad spectrum antibiotic use in the NICU following collaboration with neonatology providers. The team recently worked to create an antibiogram-guided urinary tract infection guidance document for the pediatric emergency department to improve antimicrobial prescribing for pediatric urinary tract infections. They also created a pediatric penicillin allergy team which performs allergy assessments on patients with a labeled penicillin and/or cephalosporin allergy at M Health Fairview Masonic Children’s Hospital to remove inaccurate allergy labels. The team looks forward to expanding this program to include inpatient allergy testing.
• Collaboration:
  M Health Fairview Masonic Children’s Hospital created an antibiogram-guided urinary tract infection guidance document for the pediatric emergency department to improve antimicrobial prescribing for pediatric urinary tract infections. They engage with other Fairview hospitals at health-system meetings to ensure consistency of protocols, outcomes measurement, and educational efforts. Dr. Meredith Oliver and Dr. Laura Norton are members of MOHASC health care subgroup and participate in statewide efforts around One Health antimicrobial stewardship. They have experience implementing a pharmacist-driven penicillin and cephalosporin allergy assessment tool and plan to educate other facilities (nationally) about the penicillin allergy program this year.

• Physician Leader: Aditya Chandorkar, MBBS
• Pharmacist Leader: Jennifer Ross, PharmD, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  Northland is one of two tele-antimicrobial stewardship sites within M Health Fairview. They are working to include standardized antimicrobial administration ratio (SAAR) data within the electronic health record for real-time access and evaluation alongside days of therapy data. Northland has collaborated with other smaller acute care sites within M Health Fairview to start benchmarking National Healthcare Safety Network (NHSN) SAAR data.
• Collaboration:
  The Northland tele-antimicrobial stewardship program has provided formal mentorship to an acute care site within the M Health Fairview system of similar size in Hibbing, Minnesota, with no ID consultation service/provider on-site. They have discussed tracking, reporting, and assessment practices of antimicrobial stewardship data. In addition, they have joined rounds and provided expertise and highlighted their daily antimicrobial stewardship workflows within the electronic record and tele-communication practices with providers. They serve as a resource to discuss tough cases, both inpatient and outpatient, as the site also manages an infusion center.

• Physician Leader: Steven Dittes, MD
• Pharmacist Leader: Ronald Greenberg, PharmD, BCPS
• Highlighted Antibiotic Stewardship Activity:
  All cases of hospital-onset C. difficile infections are reviewed by a multi-disciplinary team including infection prevention, nurse managers, environmental services, a hospitalist, and the antimicrobial stewardship pharmacist. A meeting is scheduled following all hospital onset C. difficile cases and any learnings/opportunities for improvement are identified and shared.
• Collaboration:
  M Health Fairview Ridges Hospital participates in the MDH NHSN AU Option User Group which meets quarterly. Data regarding antimicrobial use at M Health Fairview Ridges Hospital is shared with MDH, which is then compiled into a quarterly individualized report that summarizes antimicrobial use at our institution and provides relevant comparisons to the antimicrobial use of other Minnesota hospitals. This group intends to discuss trends in antimicrobial use and facilitate information exchange between health systems in our state.

• Physician Leader: Steven Dittes, MD
• Pharmacist Leader: Carolyn Brands, PharmD, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  M Health Fairview Southdale's ASP/ID pharmacist participates in the interdisciplinary Hospital-Acquired Infections Committee, which discusses patient-specific CAUTI and CLABSI cases as well as general hospital trends to identify opportunities to improve hospital-acquired infection rates. The antimicrobial stewardship pharmacist is also a member of the health-system Sepsis Committee and is involved in work to optimize antibiotic use in septic patients by providing guidance to providers in their assessment of infectious vs non-infectious causes of sepsis. This year, they led a project to develop a guideline for Sepsis Antibiotic Administration for Nursing Homes to help nurses decide which antibiotics to prioritize giving to septic patients when multiple are ordered.
• Collaboration:
  The hospital participates in the MDH NHSN AU Option User Group which meets quarterly. Data regarding antimicrobial use at M Health Fairview Southdale is shared with MDH, which is then compiled into a quarterly individualized report that summarizes antimicrobial use at the institution and provides relevant comparisons to the antimicrobial use of other Minnesota hospitals. This group intends to discuss trends in antimicrobial use and facilitate information exchange between health systems in our state.

• Physician Leader: Edwin Pereira, MD
• Pharmacist Leader: Laurel Thomas, PharmD
• Highlighted Antibiotic Stewardship Activity:
  M Health Fairview- St. John's Hospital utilizes vancomycin Area Under the Curve (AUC) via Bayesian software for dosing and monitoring vancomycin. This is recommended as best practice per newly published guidelines, this change was implemented in clinical practice in 2021. Clinical outcomes associated with this change in practice are currently being evaluated. Additionally, the antibiotic stewardship team is evaluating several special populations (e.g., patients on continuous renal replacement therapy and CNS infections) where data is lacking for utilizing AUC dosing and monitoring.
• Collaboration:
  St. John’s Hospital participates in regional coordination of data, protocols, and best practices amongst all M Health Fairview sites as well as site involvement and membership in our System Antimicrobial Stewardship Committee. All M Health Fairview Epic users have access and can see site specific antimicrobial usage reports in Epic. Access to hospital specific antibiograms throughout the whole health system.
  M Health Fairview – St. John’s participates in the MDH NHSN AU Option User Group which meets quarterly. Data regarding antimicrobial use is shared with MDH which is then compiled into a quarterly individualized report that summarizes antimicrobial use at our institution and provides relevant comparisons to the antimicrobial use of other Minnesota hospitals. This group intends to discuss trends in antimicrobial use and facilitate information exchange between health systems in our state.

• Physician Leader: Edwin Pereira, MD
• Pharmacist Leader: Laurel Thomas, PharmD
• Highlighted Antibiotic Stewardship Activity:
  M Health Fairview Woodwinds Hospital utilizes vancomycin Area Under the Curve (AUC) via Bayesian software for dosing and monitoring vancomycin. This was recommended as best practice per newly published guidelines and in 2021 they implemented this change in clinical practice. They are currently evaluating clinical outcomes associated with this change in practice, and additionally, they are evaluating several special populations (e.g., patients on continuous renal replacement therapy and CNS infections) where data is lacking for utilizing AUC dosing and monitoring.
• Collaboration:
  M Health Fairview Woodwinds participates in regional coordination of data, protocols, and best practices amongst all M Health Fairview facilities. Woodwinds maintains membership in the System Antimicrobial Stewardship Committee. All M Health Fairview Epic electronic health record users have access and can see site specific antimicrobial usage reports in Epic. The M Health Fairview health system provides access to hospital specific antibiograms.  
  Additionally, M Health Fairview Woodwinds Hospital participates in the Minnesota Department of Health National Healthcare Safety Network Antibiotic Use Option (MDH NHSN AU Option) User Group which meets quarterly. Data regarding antimicrobial use at the hospital is shared with MDH which is then compiled into a quarterly individualized report that summarizes antimicrobial use at our institution and provides relevant comparisons to the antimicrobial use of other Minnesota hospitals. This group intends to discuss trends in antimicrobial use and facilitate information exchange between health systems in Minnesota.

• Physician Leader: Susan Kline, MD
• Pharmacist Leader: Lina Hamid, PharmD, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  University of Minnesota Medical Center (UMMC) expanded the antibiotic timeout pilot, which started in March 2022, to all medicine and surgical units in March 2023. Patients started on empiric antibiotics for urinary tract infection (UTI) or community-acquired pneumonia (CAP) are screened and assessed by unit pharmacist for appropriateness of therapy. Pharmacists then reach out to primary provider to discuss optimization of therapy which includes de-escalation, discontinuation, dose adjustment, intravenous (IV) to oral (PO) conversion, and defining duration of therapy in accordance with local and national guidelines. UMMC has been able to streamline this process by building a tool within the electronic medical record (EMR) to quickly identify patients and improve documentation of interventions.
  In 2022, UMMC continued to streamline its multidisciplinary outpatient parenteral antimicrobial therapy (OPAT) program. Several EMR enhancements have allowed ID pharmacists to prospectively review outpatient parenteral antibiotic plans more efficiently at the time of or closer to hospital discharge and standardize our electronic communication with key OPAT stakeholders across the care continuum. ID pharmacist reconciliation of OPAT plans has aided in transitions-of-care optimization by decreasing OPAT-attributable adverse effects and unscheduled healthcare use (i.e., Emergency Department visits and hospital readmissions) and identification of a designated OPAT provider. Interventions made by ID include OPAT avoidance with IV to enteral antimicrobial switches and OPAT antimicrobial selection, dosing, therapeutic drug monitoring, culture follow-up, duration of therapy, and laboratory monitoring.
• Collaboration:
  UMMC participates in the Minnesota Department of Health National Healthcare Safety Network Antibiotic Use Option (MDH NHSN AU Option) User Group which meets quarterly. Data regarding antimicrobial use at the hospital is shared with MDH which is then compiled into a quarterly individualized report that summarizes antimicrobial use at our institution and provides relevant comparisons to the antimicrobial use of other Minnesota hospitals. This group intends to discuss trends in antimicrobial use and facilitate information exchange between health systems in Minnesota.

• Physician Leader: Laurel Cushing, MD
• Pharmacist Leader: Hailey McCoy, PharmD
• Highlighted Antibiotic Stewardship Activity:
  • Pharmacists at Maple Grove Hospital receive calls on organism ID from rapid blood culture diagnostics. Then utilize a clinical algorithm to help direct the targeted therapy that is reviewed and updated annually. 
  • Pharmacists have also discontinued vancomycin based on negative MRSA PCR results when being utilized only for non-ventilator-associated pneumonia.
  • Pharmacists follow up on culture results in the emergency department to assist in optimizing outpatient antimicrobial therapy. Including helping to facilitate prescribing of oral antiviral therapy for COVID-19.
• Collaboration:
  Maple Grove Hospital shares antibiotic stewardship with North Memorial Health. Providers, nursing, pharmacy, infection prevention and leadership at both hospitals identify both shared and unique goals based on site and patient populations served. Through this collaboration both hospitals are able to develop workflows and clinical tools that can be utilized in multiple settings. Maple Grove Hospital shares antibiotic use and resistance data with each site to compare trends and identify opportunities. Maple Grove Hospital also combines ER data to create a more robust antibiogram annually specific to the ER.

Austin, Albert Lea, Red Wing, Lake City, and Cannon Falls

• Physician Leader: Gina Suh, MD
• Pharmacist Leader: Kelsey Jensen, PharmD, BCPS, BCIDP
• Collaboration:
  Mayo Clinic Health System (MCHS) Southeast Minnesota Region Antimicrobial Stewardship Program Team provides stewardship services to MCHS hospitals within the region including Austin, Albert Lea, Red Wing, Lake City, and Cannon Falls, and to nearby MCHS outpatient clinics. Antimicrobial use data are tracked and reported for the entire MCHS Southeast Minnesota region. Stewardship education is provided to staff throughout the region, and stewardship initiatives are generally implemented concurrently at all sites. The MCHS Southeast Minnesota Region Antimicrobial Stewardship Program (ASP) team regularly collaborates with the MCHS Southwest Minnesota ASP team to develop and implement stewardship initiatives such as the intraabdominal infection vertical stewardship initiative (described above). The Southeast and Southwest teams meet at least quarterly. There is also regular collaboration between Antimicrobial Stewardship Teams at all Mayo Enterprise sites. The Enterprise Antimicrobial Stewardship Team meets bi-monthly to discuss ongoing projects and to facilitate collaboration and cross-pollination of ideas.

Mankato, Fairmont, St. James, New Prague, and Waseca 

• Physician Leader: Cristina Corsini Campioli, MD
• Pharmacist Leader: Kellie Hannan, PharmD, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  The Mayo Clinic Health System – Southwest MN Region antimicrobial stewardship team completes daily (Monday - Friday) reviews of patients who have potentially inappropriate antimicrobial therapy as identified by monitoring rules in the electronic medical record (i.e., bug-drug mismatch, restricted antimicrobials, alerts for broad-spectrum agents ordered for targeted community-acquired infections such as pneumonia, skin and soft tissue infections, and intra-abdominal infections, timeouts for broad-spectrum agents). A multidisciplinary team reviews all cases of hospital-acquired C. difficile and works on prospective quality improvement initiatives to prevent future infections.
  In the ambulatory care setting, MCHS Southwest Minnesota implemented order panels, patient education materials, and provider peer comparison reports to improve antibiotic prescribing for respiratory tract infections. They reduced antibiotic prescribing for upper respiratory infection diagnoses where antibiotics are not indicated to <10% in 2021 and have sustained that progress into 2023.
• Collaboration:
  A regional antimicrobial stewardship (ASP) team provides stewardship services to Mayo Clinic Health System (MCHS) hospitals in Mankato, Fairmont, New Prague, St. James, and Waseca and to nearby MCHS outpatient clinics. Antimicrobial use data is tracked and reported for the entire MCHS Southwest Minnesota region. Stewardship education is provided to staff throughout the region, and stewardship initiatives are generally implemented concurrently at all sites. The MCHS Southwest ASP team regularly collaborates with the MCHS Southeast ASP team to develop and implement stewardship initiatives such as the cellulitis vertical stewardship initiative described above. They work collaboratively with ASP team across the Mayo Clinic Enterprise (Minnesota, Wisconsin, Arizona, and Florida) to improve antibiotic use in the ambulatory care setting. They have shared data and change management strategies and have reduced antibiotic use for upper respiratory tract infections and are now working to reduce durations of therapy for urinary tract infections.

• Physician Leader: Aaron Tande, MD
• Pharmacist Leader: Lynn Estes, PharmD
• Highlighted Antibiotic Stewardship Activities:
  • The antimicrobial stewardship team performs daily (Monday - Friday) reviews of patients who have identified by about 90 internally developed rule algorithms to detect potentially suboptimal antimicrobial therapy.
  • Mayo Clinic has a very robust, internally developed antimicrobial analytics program that allows selection of date range, filtering by hospital, unit(s), provider team(s), selected drug(s), indications of use, desired metric (DOT/1000 pt days, % of patients, duration of therapy, #of doses etc.). Data can be displayed in various graphical or tabular forms, control charts, and recently ability to set automated alerts for antimicrobial use outside of parameters was implemented. 
  • Clinical resources for antimicrobials and infectious syndrome management are available to staff from our internally developed Ask Mayo Expert program and our Mayo Clinic Antimicrobial Therapy Quick Guide.
  • An IV to PO conversion procedure is in place to allow pharmacists to automatically convert antimicrobials from IV to PO if appropriate criteria are met, and pharmacists can also adjust antimicrobial doses and order related lab tests.
  • Beyond the inpatient care setting, a multifaceted approach to outpatient antimicrobial stewardship has been implemented. This includes the establishment of an annual goal (e.g., optimizing antimicrobial prescribing in upper RTIs and UTIs), implementation of evidence-based practice guidelines in the form of pre-populated order sentences, patient education, tracking and reporting of outpatient prescribing data, and staff education.
• Collaboration:
  The ASP at Mayo Clinic Rochester is responsible for stewardship activities within Mayo Clinic Rochester Hospital (i.e., Rochester Methodist Hospital and Saint Marys Hospital) but also has implemented efforts to optimize antimicrobial use in primary, urgent care, and emergency care for a large ambulatory practice encompassing several clinic locations in Rochester and surrounding communities. The Mayo Clinic Rochester ASP is also very active in the Enterprise Antimicrobial Stewardship program (EASP). EASP is a coordinated effort from all Mayo Clinic sites to collaborate on projects and program optimization pertaining to antimicrobial stewardship efforts implemented in the Mayo Clinic Enterprise, including sites in the midwest, Arizona, and Florida. Such involvement includes the development and optimization of antimicrobial data platforms to facilitate antimicrobial trending/tracking/benchmarking, refinement of clinical pathways, local guidelines, and order sets, multiple quality improvement projects (e.g., optimizing antimicrobial prescribing in inpatients with pneumonia, penicillin allergy management), design and provision of educational activities, and development and refinement of ASP prospective audit rules. In addition, ASP team members serve as liaisons to the Mayo Clinic Care Network. This allows for the team's ASP expertise to be offered, upon request, to network members with specific questions pertaining to antimicrobial and stewardship practices. Lastly, several members of the Mayo Clinic Rochester ASP are active within the Minnesota One Health Antibiotic Stewardship Collaborative.

• Physician Leader: Laurel Cushing, MD
• Pharmacist Leader: Hailey McCoy, PharmD
• Highlighted Antibiotic Stewardship Activity:
  • Pharmacists at North Memorial Health Hospital receive calls on organism ID from rapid blood culture diagnostics. Then utilize a clinical algorithm to help direct the targeted therapy that is reviewed and updated annually. 
  • Pharmacists have also discontinued vancomycin based on negative MRSA PCR results when being utilized only for non-ventilator-associated pneumonia.
  • Pharmacists follow up on culture results in the emergency department to assist in optimizing outpatient antimicrobial therapy. Including helping to facilitate prescribing of oral antiviral therapy for COVID-19.
• Collaboration:
  North Memorial Health Hospital shares antibiotic stewardship with Maple Grove Hospital. Providers, nursing, pharmacy, infection prevention and leadership at both hospitals identify both shared and unique goals based on site and patient populations served. Through this collaboration both hospitals are able to develop workflows and clinical tools that can be utilized in multiple settings. North Memorial shares antibiotic use and resistance data with each site to compare trends and identify opportunities. North Memorial also combines ER data to create a more robust antibiogram annually specific to the ER.

• Physician Leader: Jon Kemp, MD
• Pharmacist Leader: Magan Rasmussen, PharmD
• Collaboration:
  All HealthPartners hospitals (Regions, Methodist, Lakeview, Hutchinson, Olivia, Westfields, Hudson, Amery) are a part of an antimicrobial stewardship program along with an infectious disease pharmacist and doctor to head the program. Antibiotic stewardship program meets at least six times a year. Hospital antibiograms are disseminated to providers yearly and annual antibiotic use summary for HealthPartners with areas of improvement are also disseminated to providers at each hospital.

• Physician Leader: Odette El Helou, MD
• Pharmacist Leader: Amy Pu, PharmD, PhD, BCIPD
• Highlighted Antibiotic Stewardship Activity:
  • Olmsted Medical Center (OMC) has created an antimicrobial stewardship dashboard to monitor antibiotic prescribing patterns. The antibiotic stewardship program utilizes this dashboard to identify areas for improvement and shares insights with prescribers as needed. The pharmacy team leads prospective audits of surgical antibiotic orders to address beta-lactam allergies. The team has also implemented a protocol for de-escalating vancomycin based on MRSA PCR results. Additionally, pharmacists at OMC engage in prospective reviews of antimicrobial prescriptions upon patient discharge, providing counseling on antibiotic use. 
  • Infection Prevention at OMC has developed a MRSA decolonization protocol for orthopedic surgery patients. OMC has also developed protocols for HIV post-exposure prophylaxis, addressing both occupational and non-occupational exposures.
• Collaboration:
  Olmsted Medical Center’s Antimicrobial Stewardship team actively participates in transition of care meetings with long-term care facilities, providing resources for testing and antimicrobial management support. Additionally, the team collaborates closely with home infusion companies to enhance the pharmacokinetics/pharmacodynamics of antibiotics such as piperacillin/tazobactam and cefepime at home infusion settings. This involves optimizing administration through extended or continuous infusion methods for selected patients

• Physician Leader: Becca Peglow, MD
• Pharmacist Leader: Zack Nelson, PharmD
• Highlighted Antibiotic Stewardship Activity:
  • Comprehensive selective/cascade reporting rules for antimicrobial susceptibility testing.
  • Penicillin allergy collaborative practice agreement and education.
  • Pilot program investigating nursing identification of patients at low risk for oral amoxicillin challenge.
  • Prospective review of discharge antimicrobial prescriptions for patients being discharged from the emergency department.
  • Develop clear HIV post-exposure prophylaxis protocols for occupational and non-occupational exposures.
  • Conducting clinical research to inform diagnostic stewardship practices around antimicrobial susceptibility testing.
  • Using guiding principles to improve consistency and equity across the care continuum within the health system.
• Collaboration:
  • Member of the Minnesota One Health Antimicrobial Stewardship Collaborative.
  • Many coordinated systemwide initiatives including: vancomycin AUC transition, extended infusion piperacillin/tazobactam, empiric guideline development, system renal dosing protocols, development of a centralized AS webpage.
  • Participant in the MDH quarterly NSHN AU user group meetings.
  • Focus on improving relationship with smaller hospitals within the health system.
  • Collaboration with microbiology to investigate new diagnostic and susceptibility testing technology.
  • Collaboration with systemwide information technology to facilitate multiple stewardship interventions.
  • Park Nicollet Methodist Hospital tries to engrain stewardship in the development of learners within pharmacy and medicine by having most family medicine resident physicians rotate with the antimicrobial stewardship program.

• Physician Leader: Becca Peglow, MD
• Pharmacist Leader: Mary Ullman, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activities:
  • Dalbavancin initiative to decrease length of stay in those not a candidate for IV outpatient parenteral antibiotic therapy. 
  • Verigene review by antimicrobial stewardship pharmacist for targeted de-escalation.
• Collaboration:
  Regions Hospital developed a discharge order set for patients requiring antimicrobials on discharge to ensure appropriate monitoring and follow-up.

• Physician Leader: Lucio Minces, MD
• Pharmacist Leader: Nathan Goracke, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Rice Memorial participates in a collaborative, multi-site antimicrobial stewardship program with seven other hospital sites, meeting at least quarterly to share insight, protocols, and stewardship information. In addition, the Rice Memorial infectious disease (ID) physician mentors and facilitates stewardship practices with four other area facilities, providing important expertise and consulting on initiatives. Rice Memorial also hosts a monthly ID journal club via teleconference with other facilities in the region and shares their antibiogram data with more than ten other sites.
• Collaboration:
  Rice Memorial’s infectious disease physician mentors and facilitates stewardship practices in collaboration with four area facilities. These sites then have the expertise of an infectious disease physician for protocol implementation, infection control, and consulting among other stewardship initiatives.

• Physician Leader: Elliot Francke, MD Infectious Disease
• Pharmacist Leader: Kelly Kabat, PharmD, BCPS
• Highlighted Antibiotic Stewardship Activity:
  In reviewing days of therapy data, meropenem was found to be used more than cefepime and other broad spectrum comparators during some months at Ridgeview Medical Center. This data was shared with hospitalists at Adult Medicine Service Line and discussions on use involving Ridgeview stewardship leaders and the infectious disease team surrounding occurred. As a result, it was suggested  to build out questions on the meropenem order in Epic to help drive appropriate use and suggest alternatives if applicable.  These questions included:
  • Indication for antibiotic (required for all antibiotics ordered in Ridgeview's Epic)
  • Additions added for meropenem:
    1. Does the patient have an anaphylactic-type reaction to penicillin and/or cephalosporins?
    2. Does the patient have a history of multi-drug resistant organisms, specifically ESBL?
  • Process instructions: If you answered no to either question, please consider alternative agent. If broad spectrum antibiotics are necessary, consider alternative agents such as piperacillin/tazobactam or cefepime. 
• Collaboration:
  Ridgeview Waconia continues to partner with their critical access site hospitals to complete antimicrobial stewardship daily. Waconia campus pharmacists review patients with antibiotics on the weekends and any new orders placed in the evenings. This partnership also continues during transfer from one facility to another (ex. Ridgeview Waconia inpatient to Ridgeview Le Sueur swing bed).
  In addition, the Ridgeview Medical Center lab continues to provide antibiogram data to the long-term care facility near the Waconia hospital campus. Finally, the Ridgeview Medical Center collaboration with their outpatient clinic sites continues to grow through access to pharmacists to review antibiotic questions with clinic providers, antimicrobial stewardship committee membership, and formal education.

• Physician Leader: Thomas Math, MD
• Pharmacist Leader: Ann Wigton, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  St. Cloud Hospital has required indications for all IV and oral antibiotic orders. A prompt for adding duration of therapy for oral fluoroquinolone orders. A pharmacy renal dosing policy and pharmacy-to-dose protocols for vancomycin and aminoglycosides. Provider notification of patients with broad-spectrum antibiotics ordered for greater than 72 hours. As well as pharmacy IV to oral antibiotic conversion policy.
• Collaboration:
  St. Cloud Hospital has recently started including representation from all facilities in the health system at local antimicrobial stewardship committee meetings. In this committee, representatives from other facilities in the health system can attend and receive assistance with antimicrobial stewardship/infectious disease related issues. In turn, all are welcome to give feedback on other topics discussed, which allows for a broader viewpoint for discussion. 
  The Antimicrobial Stewardship/Infectious Disease Pharmacist at St. Cloud Hospital serves as a resource to pharmacists and providers across the health system.

• Physician Leader: Sara Lund, MD
• Pharmacist Leader: Joy Bittner, PharmD, BCPS
• Highlighted Antibiotic Stewardship Activity:
  ASP rounds are conducted on Tuesdays and Fridays and provide clinical pharmacists the opportunity to review patients with the infectious disease physicians after completing prospective audit. Recommendations shared with the ordering provider are generally accepted. Protected antimicrobials are reviewed by a clinical pharmacist for appropriateness within 48h of initiation. This year, the ASP committee developed an institutional policy to standardize antimicrobial dosing in obese patients. Antibiotic allergy testing for inpatients is generally coordinated by members of the ASP team.
• Collaboration:
  St. Luke's ASP committee includes members from Lake view Hospital (an affiliated hospital in Two Harbors, MN) who attend quarterly meetings and implement many of the ASP initiatives at their hospital. The infectious disease physicians routinely provide formal and informal consultative services to regional hospitals and clinics that reside in northern MN, northern WI, and the upper peninsula of MI. The hospitals who are members of Wilderness Health have a formal process to seek antimicrobial stewardship or ID recommendations from St. Luke's pharmacists and/or infectious disease physicians.

• Physician Leader: Brian Niskanen, MD
• Pharmacist Leader: Nicholas Giller, PharmD, BCPS, BCOP, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  Prospective audit and feedback has helped curb much of the inappropriate antibiotic use. When Welia Health inpatient pharmacists see an inappropriate antibiotic show up in the verification queue, the prescriber is immediately called before the dose is given.
• Collaboration:
  All C. diff cases are tracked and evaluated if antibiotics were prescribed and if the antibiotics were appropriate. If inappropriate prescribing is identified in the community outside of Welia Health (e.g., local nursing homes, group homes, dental offices), they will be notified of the findings and provided education and feedback. Welia Health strongly encourages prescribers at local community nursing homes to consult their inpatient pharmacists with all infectious disease related questions. The inpatient pharmacists get many calls and provide guidance on appropriate antibiotic choice regarding urine and wound cultures for local nursing home patients.

• Physician Leaders: Gus Mellgren, MD 
• Pharmacist Leaders: Lisa Petrie, PharmD
• Highlighted Antibiotic Stewardship Activity:
  In the past year, Glacial Ridge Hospital has been working to limit Levaquin prescribing to reduce C. difficile rates. Over the previous six months the C. difficile rates have drastically dropped.

• Physician Leader: Dr. Thomas Bracken, MD
• Pharmacist Leader: Anna Crotty, PharmD
• Highlighted Antibiotic Stewardship Activity:
  The antimicrobial stewardship pharmacist worked with EMR analysts to build a report that pulls antibiotic use data from the EMR system. This report pulls data by date range and can display the date ordered, patient information, antibiotic information, prescriber information and where the antibiotic was prescribed. The pharmacist must then manually review the selected chart to gather any other pertinent, de-identified, information. 
  During the '24 Q1 report to medical staff, Mille Lacs Health System used this data to discuss the use of broad-spectrum antibiotics throughout the facility. A retrospective chart review using antibiotic prescribing data was performed to gather indication of treatment and appropriateness of therapy choice. This report is also used to perform patient-specific, retrospective chart reviews monthly. The pharmacist and physician review provider-specific charts and give provider feedback, if applicable

• Physician Leader: Jake Traxler, MD
• Pharmacist Leaders: Amy Dittmer, PharmD

• Physician Leader: Daryn Collins, MD
• Pharmacist Leader: CharlieSieberg, PharmD