Pharmacists join fight against infectious diseases with new program on Kauaʻi

A collaboration between the University of Hawaiʻi at Hilo Daniel K. Inouye College of Pharmacy and Wilcox Hospital has formed Hawaiʻi’s first interdisciplinary Antimicrobial Stewardship Program (ASP) to help combat infectious diseases on Kauaʻi.

ASPs are programs designed to improve the utilization of appropriate antibiotics with the goals of improving patient outcomes and lowering healthcare associated costs, as well as slowing the development of antimicrobial resistance.

“The management of infectious diseases is a constant arms race, and, as medication experts, pharmacists are uniquely qualified to help drive ASPs,” said Roy Goo, assistant professor in the Department of Pharmacy Practice, who is based on Kauaʻi. “As new antimicrobial agents are developed, bacterial, viral and fungal organisms evolve with new resistance mechanisms that confer immunity to even our best medications. Even with proper medication, it is estimated that 50 percent of antibiotics are used inappropriately.

“The practice of infectious diseases is the art of using only what is necessary to cure the infection and nothing more,” added Goo. “One of the basic principles of infectious diseases is the more antimicrobial agents we use, the faster resistance develops.” He points out that in recent years multiple strains of bacteria have arisen that are resistant to all currently available antibiotics.

In Hawaiʻi, Goo shows how the College of Pharmacy has played an integral role in the development of these programs across the State. With support from Wilcox Hospital’s inpatient pharmacy department and the hospital’s infectious disease physician Dr. Jimmy Yoon, students screen for patients who are on high-cost or high-risk antimicrobials. They then assess the appropriateness of the antimicrobial regimen for each patient and present their recommendations to the entire infectious disease team, who makes changes to optimize therapy.

“The Center for Disease Control strongly recommends that hospitals perform some form of antimicrobial stewardship, and it is likely that it will become mandated by the Center for Medicare/ Medicaid Services (CMS) in a couple of years,” Yoon said. “At Wilcox Memorial Hospital, we like to be ahead of the curve. Right now we are lucky that we have very few resistant bacteria, and we want to keep it that way. There is a clear correlation between bacterial resistance and increased morbidity and mortality as well as healthcare costs.”

Recognizing the importance of training pharmacists to fill this growing need, Yoon often spends time with students and tests them on their drug knowledge. Students consult with members of Wilcox Memorial Hospital’s Radiology staff, who also volunteer their time to go over chest X-rays and other imaging studies to point out abnormalities that serve as possible indications of infection.

“The drug pipeline for antimicrobial agents is dry so we need to save the agents that we have,” Yoon said. “My anticipation is that for pharmacists this is going to be a huge area for growth.”

This positive experience has led to other collaborative programs at Straub Hospital and Pali Momi Medical Center (PMMC) on Oʻahu. Pharmacist Melissa Yoneda, a DKICP alumni from the Class of 2013, is currently helping to establish a pharmacy-driven ASP at PMMC in collaboration with the PMMC pharmacy, nursing and physician staff.

The release of an ASP module and guidance statement from the CDC indicates that ASPs will likely become a requirement across the United States. Certain states such as California have already made it mandatory that hospitals that enjoy Medicare reimbursement have an established ASP in place.