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.

• Minnesota Antibiotic Stewardship Honor Roll Invitation (PDF)
  The Minnesota Hospital Association, Stratis Health, the Association for Professionals in Infection Control, the Collaborative Healthcare-Associated Infection Network, and the Minnesota One Health Antibiotic Stewardship Collaborative invite hospital partners to apply for recognition on the Honor Roll.

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 annually. Renewal applications will be sent out one year 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: Krista Gens, PharmD, BCPS, BCIDP, DPLA
• Highlighted Antibiotic Stewardship Activity:
  Abbott Northwestern Hospital has piloted an antibiotic stewardship program in the home hospital setting, and pharmacists review records for patients discharging on IV antibiotics to ensure appropriate care.
• Collaboration:
  The Abbott Northwestern Hospital stewardship program provides best practice education, prospective audit with feedback, and stewardship data coordination to multiple critical access hospitals.

• 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
• Highlighted Antibiotic Stewardship Activity:
  The Bigfork Valley Hospital team created an electronic medical record report, "Prescriber Antibiotic Stewardship Performance Report," that details patient, drug, frequency, stop/start dates, clinical indication, and ordering provider. This report is reviewed by the stewardship program and shared with prescribers. It can be used to identify opportunities for improvement in prescribing practices.
• Collaboration:
  Bigfork Valley Hospital works closely with other rural Minnesota critical access hospitals serviced by the same after-hours pharmacy provider. Together, this group of pharmacy leaders learns about stewardship initiatives at each facility. Through this collaboration, initiatives (e.g., Bigfork Valley Hospital's days of therapy tracker) may be adopted by other sites.

• Physician Leader: Ulrika Wigert, MD
• Pharmacist Leader: Dennis Heinen, RPh
• Highlighted Antibiotic Stewardship Activity:
  The CentraCare - Sauk Centre stewardship team utilizes prospective audit with feedback as an intervention to optimize antibiotic therapy and to educate providers.
• Collaboration:
  CentraCare - Sauk Centre collaborates with other hospitals in the region to develop and discuss protocols for antimicrobial therapies and changes needed to those protocols. The hospital also collaborates in development of a regional antibiogram. The antibiogram is shared with six CentraCare hospitals and is used to create appropriate order protocols for the system. The antibiogram is available for providers and pharmacist on patient-specific case issues.

• Physician Leader: John Hering, MD
• Pharmacist Leader: Kaitlyn Stenberg, PharmD, BCPS
• Highlighted Antibiotic Stewardship Activity:
  CentraCare Health Monticello reports both antibiotic administration and antimicrobial resistance data to CDC through the National Healthcare Safety Network Antimicrobial Use and Resistance Module.
• Collaboration:
  CentraCare Health Monticello works in collaboration with all of the other CentraCare and Carris Health sites on antimicrobial stewardship, meeting on a quarterly basis to review best practices, order sets, and education. CentraCare Monticello collaborates with the Monticello Care Center to dose and monitor vancomycin for long-term care residents, and participate in other antimicrobial stewardship and infection prevention activities.

• Physician Leader: Nathan Harris, MD
• Pharmacist Leader: Jodi Behrens, PharmD
• Highlighted Antibiotic Stewardship Activity:
  CHI St. Joseph's Hospital uses evidence-based treatment and prescribing guidelines for community-acquired pneumonia, hospital-acquired pneumonia, urinary tract infection, and sepsis.
• Collaboration:
  CHI St. Joseph's Health shares their hospital antibiogram with local health care facilities and answers questions from facilities about interpretation. The stewardship team coordinates antibiotic length of therapy for patients discharged to nursing homes and other facilities. CHI St. Joseph's Health utilizes social media videos to inform the community about COVID-19 vaccination and viral vs. bacterial infections and treatments.

• 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: Sandra Martsching, MD and Angela Skyberg, PA
• Pharmacist Leader: Janna Engel, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Essentia Health Ada uses guidelines to guide treatment of pediatric sinusitis, pediatric acute otitis media, pediatric lower respiratory tract infection, pediatric upper respiratory infection, pediatric Streptococcus infection, Lyme disease, anaplasmosis, and ehrlichiosis.
• Collaboration:
  Essentia Health Ada works collaboratively with St. Joseph's Medical Center in Brainerd, MN, sharing protocols and data to help ensure best practices and a consistent patient experience. Both pharmacies review medication documentation, and meet monthly to discuss relevant updates to standards of practice.

• 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: Julia Sybrant, PharmD, MPH
• Highlighted Antibiotic Stewardship Activity:
  An antimicrobial stewardship timeout occurs 48 hours after first administration and includes pharmacist review of culture sensitivity data, duration, use of alternative agents, etc.
• Collaboration:
  Essentia Health Duluth works closely with Essentia Health St. Mary's Medical Center and Essentia Health St. Mary's Hospital of Superior when transitioning patients from the hospital for continued care. When a patient transfers in from an outside hospital (affiliated or non-affiliated) the pharmacist obtains any culture reports that may have been taken, as well as determining what antibiotics were administered and when the last dose was received to ensure that there is continuity of care. Patients move from Essentia Health St. Mary's Medical Center to Essentia Health Duluth, where they receive dialysis, including a hand-off to ensure any antibiotic that needs to be administered to the patient following completion of dialysis is administered on time. Essentia Health Duluth pharmacists also support long-term care facilities where an every 18 hour regimen may be difficult to manage. Communication between the sites occurs through Option Care, detailing when the last dose was administered, relevant levels (e.g., vancomycin), and a plan for follow up.

• 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 reports antimicrobial administration data to CDC through the National Healthcare Safety Network AU Option. These data are used by CDC and Minnesota Department of Health to track use for hospitalized patients. Hospitals use the Standardized Antimicrobial Administration Ratio to compare prescribing to that of similar hospitals.
• Collaboration:
  The Essentia Health Northern Pines pharmacy offers formal consultative services to the local long-term care facility and provides recommendations to optimize antimicrobial therapy. Orders for antimicrobials are reviewed for appropriate dose, duration, and indication using current Essentia Health antimicrobial treatment guidelines and antibiograms.

• 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: Peter Henry, MD
• Pharmacist Leader: Sarah Patton, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Clinical pharmacists at Essentia Health St. Joseph's Medical Center 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:
  Recent collaboration with other facilities has primarily focused on COVID-19 therapeutics and resources, including sharing monoclonal antibody agents and COVID-19 vaccine with surrounding sites to ensure timely care of patients. In addition to this ongoing communication with health care facilities, Essentia Health St. Joseph's regularly supplies independent retail pharmacies in our community with COVID-19 vaccine. This challenging period has helped them to develop a strong network of sites in the area, and they will use these new relationships to better care for patients in their community and to be prepared to promptly respond to future public health emergencies.

• 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: Nicole M Nelson, PharmD, BCPS
• 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:
  The Antimicrobial Stewardship (AMS) Committee at LHS consists of various system leaders, including nursing leadership from the LHS Care Center. Leadership from the care center attend quarterly AMS meetings to report on prescribing practices and resistance issues identified at the institution. Through collaboration with care center leadership, annual antimicrobial stewardship education was created. Antibiotic stewardship knowledge is continuously exchanged through this partnership.

• Physician Leader: Alan Grillo, MD
• Pharmacist Leader: David Simmons, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  LifeCare Antimicrobial Stewardship team implemented a COVID-19 response program that allowed the team to rapidly identify, triage, and treat high-risk COVID-19 patients with antivirals or monoclonal antibodies to prevent worsening illness and hospitalizations.
• Collaboration:
  Collaboration with retail pharmacies has supported maintenance of adequate supplies and proper usage of oral antivirals for patients in the community with Covid-19. LifeCare hospital's antibiogram is shared with local pharmacies, clinic providers, and the long-term care facilities Greenbush Manor and Roseau Manor. Physicians providing care to residents at these long-term care facilities are part of the LifeCare medical staff and receive pharmacy-led education at medical staff meetings.

• 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:
  M Health Fairview Lakes Medical Center tracks antimicrobial stewardship intervention acceptance rates (interventions accepted within 24 hours of formal progress note). Other variables tracked include days of therapy (DOT) for all antimicrobials, with data accessible in the electronic health record and in NHSN AU Standardized Antimicrobial Administration Ratio (SAAR) reports. Review of DOT and SAAR in tandem allows the team to target antimicrobial stewardship interventions including retrospective chart review for specific antimicrobials and/or disease states.
• Collaboration:
  M Health Fairview Lakes provides tele-antimicrobial stewardship to others in the M Health Fairview system. They have focused on building trust and ensuring sound communication methods and have established formal collaboration with an ED provider to improve use of non-restricted and restricted antimicrobials for skin and soft-tissue infection (SSTI). Through regular meetings with the ED provider, they have reviewed over 100 patients seen in the ED and subsequently admitted with SSTI. These data have informed an SSTI guideline for Lakes and other M Health Fairview sites that includes "hospital-at-home" therapy considerations. This initiative goes beyond daily antimicrobial stewardship workflows, which largely focus on inpatients. Hospital-at-home is a care transition that poses unique antimicrobial stewardship challenges for parenteral antimicrobial therapy.

• 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:
  M Health Fairview Northland Regional Hospital is developing an antimicrobial stewardship dashboard for providers, pharmacists, and infection preventionists to communicate data on use of broad spectrum antimicrobial classes (i.e., anti-MRSA agents, anti-Pseudomonas aeruginosa agents, carbapenems) and quantity of completed beta-lactam allergy assessments.
• Collaboration:
  The M Health Fairview Northland Regional Hospital tele-antimicrobial stewardship program provides formal mentorship to an acute care site of similar size in the M Health Fairview system that has no onsite ID consultation service or provider. Mentorship has included sharing of tracking, reporting, and assessment practices, joint rounds, and participation in daily antimicrobial stewardship workflows within the electronic medical record system and directly with providers through tele-stewardship. The Northland Regional Hospital team serves as a resource to discuss difficult inpatient and outpatient cases.

• Physician Leader: Steven Dittes, MD
• Pharmacist Leader: Ronald Greenberg, PharmD, BCPS
• Highlighted Antibiotic Stewardship Activity:
  M Health Fairview Ridges uses prospective audit with feedback to educate providers and improve antibiotic use for individual patients. Any antimicrobial included in the facility's antimicrobial use policy, and any medication under FDA Emergency Use Authorization for COVID-19, triggers prospective audit with feedback. Provider feedback is given through multiple modes, including progress notes in the medical chart, page to the primary provider, phone, or in-person conversation.
• Collaboration:
  M Health Fairview Ridges Hospital Hospital participated in a system quality improvement project to reduce the incidence of surgical site infections (SSIs), especially associated with knee arthroplasty procedures. Incorrect preoperative antibiotic timing in relation to time of surgical incision was identified as the primary cause of an increase in SSIs across the system. M Health Fairview Ridges was chosen as the pilot site for targeted process improvement initiatives.

• 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, BCPS
• Highlighted Antibiotic Stewardship Activity:
  M Health Fairview St. John's 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 St. John's 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: 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 is recommended as best practice per newly published guidelines, and Woodwinds made the move to implement this change in clinical practice in 2021. They are currently evaluating clinical outcomes associated with this change in practice. Additionally, Woodwinds 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:
  • Regional coordination of data, protocols, and best practices amongst all M Health Fairview sites.
  • Site involvement and membership in 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 Woodwinds Hospital participates in the 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 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 the state.

• Physician Leader: Susan Kline, MD
• Pharmacist Leader: Kimberly Boeser, PharmD, MPH, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  M Health Fairview University of Minnesota Medical Center 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:
  University of Minnesota Medical Center 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: Leslie Baken, MD, FIDSA
• Pharmacist Leader: Emily Herstine, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  Maple Grove Hospital pharmacists follow up on culture results in the emergency care center 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 leadership with North Memorial Health Hospital. Together they collaborate across providers, nursing, pharmacy, infection prevention, and leadership to identify shared goals and opportunities alongside unique goals based on site and patient populations served. Through this collaboration they develop workflows and clinical tools and share antibiotic use and resistance data in order to compare trends and identify opportunities for improvement. The hospitals also combine emergency department susceptibility testing data to create a robust annual antibiogram specific to the emergency setting.

• Physician Leader: Gina Suh, MD
• Pharmacist Leader: Kelsey Jensen, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  Vertical antimicrobial stewardship initiatives are used to educate pharmacists and providers and optimize antimicrobial use for a particular disease state. In March 2021, educational presentations were delivered to targeted groups detailing guideline-driven treatment of intra-abdominal infections (IAI). Following education, inpatient pharmacists were encouraged to contact providers if unnecessarily broad therapy was initiated for the treatment of IAI to suggest preferred antimicrobial regimens. Across the Mayo Clinic Health System Southeast Minnesota region, piperacillin/tazobactam utilization for IAI indications decreased from 13.5 days of therapy (DOT)/1000 patient days in 2019-2020 to 7 DOT/1000 patient days in April-June 2021. Ciprofloxacin utilization for IAI indications decreased from 5.1 days of therapy (DOT)/1000 patient days to 1.3 DOT/1000 patient days for the same timeframe.
• Collaboration:
  Mayo Clinic Health System (MCHS) Austin/Albert Lea hospital provides remote stewardship services including prospective audit and feedback to other MCHS hospitals in Red Wing, Cannon Falls, and Lake City and leads collaborative outpatient antimicrobial stewardship initiatives for nearby MCHS outpatients clinics. All MCHS Minnesota hospitals are currently participating in a quality improvement project aimed at decreasing the total duration of antibiotics for CAP. Pharmacists are monitoring discharge prescriptions and recommending adjustments if the total duration (inpatient antibiotics plus discharge prescription(s)) exceeds guideline recommendations. This initiative aims to decrease outpatient antibiotic use in the community.

• Physician Leader: Cristina Corsini Campioli, MD
• Pharmacist Leader: Kellie Hannan, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Mayo Clinic Mankato uses electronic health records (EHR) functionality for stewardship. Clinical indication information is required for inpatient antimicrobial orders, and this electronic data can be filtered for analysis. The EHR is system is programmed with monitoring rules so that potentially inappropriate antimicrobial therapy can be quickly identified and reviewed by the stewardship pharmacist on a daily basis. A multidisciplinary team at Mayo Clinic Mankato actively reviews hospital-acquired C. difficile cases to inform prevention initiatives.
• Collaboration:
  Mayo Clinic Health System (MCHS) Mankato hospital provides remote stewardship services including prospective audit and feedback to other MCHS hospitals in Fairmont, New Prague, St. James, and Waseca and leads collaborative outpatient antimicrobial stewardship initiatives for nearby MCHS outpatients clinics. All MCHS Minnesota hospitals are currently participating in a quality improvement project aimed at decreasing the total duration of antibiotics for community-acquired pneumonia. Pharmacists are monitoring discharge prescriptions and recommending adjustments if the total duration (inpatient antibiotics plus discharge prescription(s)) exceeds guideline recommendations. This initiative aims to decrease outpatient antibiotic use in the community.

• Physician Leader: Gina Suh, MD
• Pharmacist Leader: Kelsey Jensen, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  A vertical antimicrobial stewardship initiative is undertaken as least annually to educate pharmacists and providers and to optimize antimicrobial use for a particular disease state. In March 2021, educational presentations were delivered to targeted groups detailing guideline-driven treatment of intraabdominal infections (IAI). Following this education, inpatient pharmacists were encouraged to contact providers if unnecessarily broad therapy was initiated for the treatment of IAI to suggest preferred antimicrobial regimens. Across the Mayo Clinic Health System (MCHS) Southeast Minnesota region, piperacillin/tazobactam utilization for IAI indications decreased from 13.5 days of therapy (DOT)/1000 patient days (using 2019 2020 data as baseline) to 7 DOT/1000 patient days in the post-intervention period (April-June 2021). Additionally, ciprofloxacin utilization for IAI indications also decreased from 5.1 days of therapy (DOT)/1000 patient days (using 2019-2020 data as baseline) to 1.3 DOT/1000 patient days in the post-intervention period (April-June 2021).
• Collaboration:
  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 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.

• Physician Leader: Cristina Corsini Campioli, MD
• Pharmacist Leader: Kellie Hannan, PharmD
• Highlighted Antibiotic Stewardship Activity:
  In August 2021, educational presentations were delivered to targeted groups detailing guideline-driven treatment of urinary tract infections (UTI) and asymptomatic bacteriuria. Following this education, inpatient pharmacists were encouraged to contact providers to recommend discontinuation of antibiotics for asymptomatic bacteriuria or de-escalation of antibiotics for UTI based on culture results if clinically appropriate. Across the Mayo Clinic Health System (MCHS) Southwest Minnesota region, ceftriaxone utilization for UTI indications decreased from 20.2 days of therapy (DOT)/1000 patient days in 2020 to 18.1 DOT/1000 patient days in the post-intervention period (September-December 2021).
• Collaboration:
  MCHS Southwest Minnesota Region Antimicrobial Stewardship Program Team provides stewardship services to MCHS hospitals in Mankato, Fairmont, New Prague, St. James, and Waseca and to nearby MCHS outpatient clinics. Antimicrobial use data are tracked and reported for the MCHS Southwest Minnesota region. Providers and infection preventionists from multiple sites participate in regional stewardship meetings to share ideas and coordinate efforts. Stewardship education is provided to staff throughout the region, and stewardship initiatives are generally implemented concurrently at all sites. The MCHS Southwest Minnesota ASP team regularly collaborates with the MCHS Southeast Minnesota ASP team to develop and implement stewardship initiatives such as the UTI vertical stewardship initiative (described above).

• 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: Daryn Collins, MD
• Pharmacist Leader: Charles Sieberg, PharmD
• Highlighted Antibiotic Stewardship Activity:
  New Ulm Medical Center pharmacists trained in infectious diseases routinely conduct prospective auditing of antibiotic use, identifying opportunities for de-escalation. They also conduct retrospective review of de-identified data to develop and communicate best practice antibiotic use guidelines for providers.
• Collaboration:
  New Ulm Medical Center, part of Allina Health, shares medical record system access with affiliate community partners, which allows them to utilize tools, such as the antimicrobial module for pharmacy departments. Allina Health expertise and resources extend beyond system facilities.

• Physician Leader: Leslie Baken, MD, FIDSA
• Pharmacist Leader: Emily Herstine, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  North Memorial Health Hospital pharmacists support clinician interpretation of organism identification from rapid blood culture diagnostics, utilizing an algorithm to help direct to targeted therapy. The algorithm is reviewed and updated annually.
• Collaboration:
  North Memorial Health Hospital shares antibiotic stewardship leadership with Maple Grove Hospital. Together they collaborate across providers, nursing, pharmacy, infection prevention, and leadership to identify shared goals and opportunities alongside unique goals based on site and patient populations served. Through this collaboration they develop workflows and clinical tools and share antibiotic use and resistance data in order to compare trends and identify opportunities for improvement. The hospitals also combine emergency department susceptibility testing data to create a robust annual antibiogram specific to the emergency setting.

• 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: 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:
  Clinical pharmacists review daily antimicrobial use reports, including every ordered antibiotic, antiviral, and antifungal prescription, to ensure appropriate use. Interventions can then be made on the basis of such review, if necessary.
• Collaboration:
  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.

• Physician Leader: Elliot Francke, MD
• Pharmacist Leader: Kelly Kabat, PharmD, BCPS
• Highlighted Antibiotic Stewardship Activity:
  The Ridgeview Medical Center antimicrobial stewardship committee conducts case-based reviews of rejected stewardship interventions. If a rejected intervention has broader impact (e.g., not following evidence-based guideline processes), education is created and shared with individual providers or across the organization, as appropriate.
• Collaboration:
  Ridgeview Medical Center partners with two critical access hospital sites, Arlington and Le Sueur, to support antimicrobial stewardship initiatives. Team members from both sites participate in monthly committee meetings. In addition, the antimicrobial stewardship committee has expanded to include a clinic pharmacist. This change is intended to bring more stewardship activities into clinic locations and was implemented at the request of clinic providers looking for more antimicrobial use education.

• Physician Leader: Sara Lund, MD
• Pharmacist Leader: Joy Bittner, PharmD, BCPS
• Highlighted Antibiotic Stewardship Activity:
  Inpatient pharmacists and infectious diseases physicians conduct antibiotic stewardship rounds twice weekly and communicate recommendations to attending providers. The antimicrobial stewardship committee has focused efforts on improving antibiotic use in patients with beta-lactam allergies or adverse drug reactions, and optimizing perioperative cefazolin use for surgical patients.
• Collaboration:
  St. Luke's inpatient pharmacists and infectious diseases physicians have collaborated with rural hospitals who are members of Wilderness Health to be available for antimicrobial or infectious disease questions and discussion.

• 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 Leader: Gina Suh, MD
• Pharmacist Leader: Kelsey Jensen, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  Mayo Clinic Cannon Falls conducts retrospective case review with providers, RNs, and pharmacy to identify opportunities to improve antibiotic therapy.

• Physician Leader: Cristina Corsini Campioli, MD
• Pharmacist Leader: Kellie Hannan, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Order sets within the electronic medical record system have been built to facilitate guideline concordant antimicrobial prescribing. Example inpatient order sets include sepsis, pneumonia, C. difficile, cellulitis, and intra-abdominal infection.

• Physician Leader: Gina Suh, MD
• Pharmacist Leader: Kelsey Jensen, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  In August 2021, educational presentations were delivered to targeted groups detailing guideline-driven treatment of urinary tract infections (UTI) and asymptomatic bacteriuria. Inpatient pharmacists contact providers to recommend discontinuation of antibiotics for asymptomatic bacteriuria or de-escalation of antibiotics for UTI based on culture results, if clinically appropriate.

• Physician Leader: Cristina Corsini Campioli, MD
• Pharmacist Leader: Kellie Hannan, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Mayo Clinic New Prague incorporates preauthorization of restricted antimicrobials as a pharmacy-driven approach to educate providers and optimize antimicrobial use.

• Physician Leader: Gina Suh, MD
• Pharmacist Leader: Kelsey Jensen, PharmD, BCPS, BCIDP
• Highlighted Antibiotic Stewardship Activity:
  Mayo Clinic Red Wing utilizes antimicrobial formulary restriction for a list of antimicrobials reserved for specific use scenarios. If a medication from the restricted antimicrobials list is ordered, pharmacy will verify and ensure that restriction criteria are met prior to order verification.

• Physician Leader: Cristina Corsini Campioli, MD
• Pharmacist Leader: Kellie Hannan, PharmD
• Highlighted Antibiotic Stewardship Activity:
  The Mayo Clinic St. James outpatient antimicrobial stewardship goal for 2021 was to reduce antibiotic prescribing for upper respiratory infections (URIs), focusing on viral URIs where antibiotics are not indicated. Educational presentations were given to ED and family medicine provider groups to review antibiotic recommendations for URIs, communication strategies for patients who request antibiotics for viral infections, and symptomatic management recommendations.

• Physician Leader: Cristina Corsini Campioli, MD
• Pharmacist Leader: Kellie Hannan, PharmD
• Highlighted Antibiotic Stewardship Activity:
  Antibiotic use data are available via a dashboard that allows for filtering by antimicrobial, indication of use, facility, unit, etc. Ciprofloxacin, levofloxacin, cefepime, piperacillin/tazobactam, ceftriaxone, ertapenem, meropenem, daptomycin, and vancomycin usage is reported to key stakeholders quarterly. Changes in antibiotic use may prompt medication use evaluations to assess appropriateness of use and/or other interventions as needed.