Spotlights on antibiotic stewardship, awards, new technology
Throughout the year, Gifford providers and staff earned media coverage for their demonstrated clinical leadership and outcomes. From individual awards for excellence to recognition of whole teams, here are a few highlights:
Stewardship at Gifford Sees Antibiotics Use Cut by Half
(Watch WCAX coverage here.)
The work by the Antibiotic Stewardship Committee at Gifford Medical Center to address antibiotic resistance, a continuing public health threat across the United States and globally, has resulted in a greater than 50 percent reduction in the use of the drugs with Gifford patients.
Overuse of antibiotics contributes to antibiotic resistance, the ability of bacteria to resist the effects of the medications that were once successful in treating them. According to a recent report by the Centers for Disease Control (CDC), “More than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result.”
Gifford’s multidisciplinary Antibiotic Stewardship Committee includes physicians, pharmacists and infection prevention specialists. Over the last year and a half, the committee has developed protocols that have been implemented across the medical center’s inpatient units to reduce the number of antibiotics prescribed.
“We are attacking the issue of antibiotic resistance from various angles, and have cut the number of antibiotics we’re using with our patients by more than half,” said Gifford Chief Medical Officer Dr. Joshua White.
White shared data indicating Gifford inpatient days of antibiotics therapy from September 2017 through April 2019. Comparing April 2018 with April 2019, for example, per 1,000 patient days, Gifford usage dipped from 496 days of antibiotics therapy to 213 days.
The Antibiotic Stewardship Committee’s initiatives include a 72-hour antibiotic timeout, in which antibiotics are stopped during inpatient rounds to review whether they are still needed and whether the medication is the appropriate antibiotic; Gifford-specific adult and pediatric quick reference guides for clinic and Emergency Department providers; and increased provider education, including review of stewardship efforts and reports at medical division meetings.
In addition, Gifford has implemented a procalcitonin (PCT) testing strategy to evaluate the use of antibiotics in lower-respiratory infections. The test can be helpful in determining whether antibiotics should be used, as high levels of PCT indicate a bacterial infection while low levels indicate a viral infection or other cause.
“Overuse of antibiotics for lower respiratory tract infections,” according to a study published by the National Institutes of Health (NIH), “is one of the most urgent and difficult stewardship problems in U.S. hospitals, accounting for much of the unnecessary antibiotic use in the inpatient setting.”
Gifford’s antibiotic stewardship is bucking national trends, said White. He referred to the rise of quinolone-resistant E. coli in the U.S. Quinolones are a class of antibiotics.
“For the second year in a row, we have seen an increase in quinolone sensitivity of E. coli in our urine studies – the exact opposite of what is happening on the national stage,” said White.
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Megan O’Brien Receives Nurse Practitioner State Award for Excellence
In December, the American Association of Nurse Practitioners (AANP) recognized Gifford Family Nurse Practitioner Megan O’Brien with the AANP Nurse Practitioner State Award for Excellence.
O’Brien, who cares for patients as part of the hospitalist team at Gifford, will be honored for her achievement in June 2020 during the AANP National Conference in New Orleans, La.
“Megan is an invaluable member of our team and we congratulate her on this well-deserved award,” said Gifford Chief Medical Officer Dr. Joshua White. “She is committed to providing the best possible care for our patients, advocating for her colleagues, and continually building upon the strength of our hospitalist program.”
Michelle Wade, APRN, president of the Vermont Nurse Practitioners Association, works with O’Brien at Gifford. As hospitalists they provide specialized, day-to-day care for inpatients. Wade nominated O’Brien for the award, citing her leadership skills and development and implementation of in-service trainings.
“Megan excels not only in providing the highest quality specialized care for patients who are hospitalized at Gifford but also in forging the way for other nurse practitioners and staff,” said Wade, who also serves as the Vermont representative to the American Association of Nurse Practitioners. “She is a leader in teamwork and, for example, has been instrumental in enhancing multidisciplinary bedside rounds on our unit so that our providers, therapists, care managers, social workers and nurses are optimizing coordination of patient care.”
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New Test Aids in Diagnosis of Tremor
In March 2019, the Nuclear Medicine team at Gifford announced a new test, DaTscan, is available to assist in the diagnosis of tremor in patients when symptoms don’t tell the whole story.
Specifically, DaTscan helps a physician confirm diagnosis by distinguishing Parkinson’s disease or other parkinsonian syndromes (PS) from essential tremor (ET), a nervous system disorder characterized by rhythmic shaking. The test may be ordered when patients have mild or atypical symptoms that do not match the diagnostic criteria for either PS or ET, or when symptoms overlap or resemble those of different movement disorders.
“The test is most useful if the appearance of the tremor is atypical and the diagnosis is not straightforward,” said Gifford Neurologist Dr. Robin Schwartz. “Often the examination is enough to make this diagnosis, but in situations in which there is confusion, the scan becomes useful. There can be a small chance of false positive and false negative, as with any test, but it can be very helpful if the diagnosis of tremor is in question.”
Gifford Nuclear Medicine Supervisor Tera Benson explained that, without the test, patients might have to wait for their symptoms to progress before receiving clinical diagnosis.
“It is pretty exciting that we are able to offer this test locally, here at Gifford,” Benson said.
Produced by GE, DaTscan is the only Food and Drug Administration (FDA)-approved visual adjunct imaging agent to aid in the differentiation between essential tremor and parkinsonian syndromes. The test does not help in distinguishing between different parkinsonian syndromes. For more information about DaTscan, visit gehealthcare.com/en/products/nuclear-imaging-agents/datscan.
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Menig Receives Nursing Home Quality Award
Staffer Claudette Goad recognized for dedication to long-term care
Gifford’s Menig Nursing Home at Morgan Orchards Senior Living Community was one of five of the state’s 36 Medicaid-participating homes to receive a 2019 Nursing Home Quality Award from the Agency of Human Services, Division of Licensing and Protection in the Department of Disabilities, Aging and Independent Living (DAIL).
Presented in late September during the annual meeting of the Vermont Health Care Association (VHCA), the award recognizes “outstanding nursing homes which have met high standards of quality of care for Vermont’s nursing home residents.” Homes were selected for the award following review of data related to providing and sustaining superior quality of care, including outcomes from recent health and satisfaction surveys. Menig previously received the award in 2005-2010 and 2012.
“This award reflects the dedication to excellence and high quality of care provided to residents daily by our team,” said Menig Administrator Ursula Margazano, who accepted the award on behalf of Menig with Director of Nursing Brooks Chapin, RN, DNS. “We are proud of our colleagues and appreciate the state recognition, which includes a financial award to further enhance the quality of service provided to our residents.”
The financial award, based on facility size, will be released at a later date.
Also at the VHCA annual meeting, Menig staff member Claudette Goad was named the 2019 VHCA Executive Assistant of the Year. Goad, who has worked at Menig for the last four of her 43 years with Gifford, was recognized for her “significant contributions and personal dedication to the long term care profession.”
“Claudette is an invaluable asset to our team,” said Margazano. “She is always ready to lend a hand anywhere one is needed, jumping in to help cover answering phones, greeting families, planning a competency day … or initiating a conversation with a resident that seems to be having a lonely day.”
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Gifford Peds 1 of 4 Practices in VT to Exceed Vaccination Targets
In May 2019, Pediatric and Adolescent Medicine at Gifford was among four practices in the state recognized by the Vermont Department of Health for achieving high immunization rates for both children and teens in 2018.
State Public Health Nurse Jan Eberly presented the Gifford team with a certificate for their achievement on May 1, during National Infant Immunization Week, marking the third year in a row Gifford has been recognized.
For a practice to receive recognition from VDH, at least 90 percent of its child patients must be up to date with immunizations for 11 vaccine-preventable diseases, including measles, mumps and whooping cough. At least 80 percent of teen patients must be vaccinated to prevent meningitis and cancers caused by human papillomavirus (HPV).
Timely “vaccination throughout childhood is essential,” according to the Centers for Disease Control and Prevention (CDC), “because it helps provide immunity before children are exposed to potentially life-threatening diseases.” Parents and caregivers are encouraged to know what immunizations their children need to stay healthy.
“We encourage parents and caregivers to make sure their children are up to date on all vaccines, and if you are unsure about vaccines, or have any questions at all, talk to your child’s doctor,” said Vermont Immunization Program Director Christine Finley. “They will give you the information you need.”
Childhood vaccines include DTaP, for diphtheria, tetanus, and pertussis; IPV, for polio; MMR, for measles, mumps, and rubella; Hib, for haemophilus influenza type b; VAR, for chickenpox; and PCV, for pneumococcal disease. Teen vaccines include HPV; Tdap, for tetanus, diphtheria, and pertussis; and MCV, for meningococcal disease.
In addition to being recognized for high immunization rates overall, Gifford Pediatric and Adolescent Medicine recently was named Vermont’s “HPV Vaccine Is Cancer Prevention Champion” for outstanding efforts to protect adolescents from cancers caused by HPV. The award, announced in December 2018 by the CDC, American Cancer Society, and Association of American Cancer Institutes, recognizes clinics and practices that go above and beyond to foster HPV vaccination in their community. Gifford was one of 32 award recipients nationwide.
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