Sarah K. Parker, MD

Dr. Sarah Parker attributes the success of her hospital’s antimicrobial stewardship program to two key factors: personal touch and pharmacy expertise. 

When she started building the Children’s Hospital Colorado program from the ground up in 2011, she had the help of a “fabulous” infectious disease pharmacist, Jason Child. Today, their antimicrobial stewardship program is one of the best supported in the nation, with three full-time pharmacists and the support of several physicians, including Dr. Parker herself.  

They examine all antibiotic use at the Aurora-based, 450-bed hospital — not just a small subset, as is often the case in such programs. What makes Children’s Colorado’s antimicrobial stewardship program even more remarkable is its novel “handshake” methodology.  

Dr. Sarah Parker attributes the success of her hospital’s antimicrobial stewardship program to two key factors: personal touch and pharmacy expertise.”

“[Initially] we built a report to look at antibiotic use across the hospital. And I would talk to Jason on the phone and say, ‘I just wish I could go talk to [the attending doctors and pharmacists] and understand what they’re doing.’ And finally, we were like, ‘Well, why can’t we?’” 

Instead of conducting antimicrobial stewardship the usual way — that is, through prior authorizations — Dr. Parker and her pharmacy colleague decided to start rounding in person, every day. They noticed they each picked up on different aspects of patient cases, and that pharmacists and clinicians had different kinds of questions about responsible antibiotic use. Taking a “soft approach” made those conversations much easier and more effective.

“The handshake methodology that we use is really important to the program’s success, I think in part because it really highlights the pharmacist. It has integrated pharmacy into all levels of the hospital … and introduces the pharmacist to the clinician in a different way, so they really come to understand the expertise that the pharmacists have to offer.” 

Since Children’s Colorado’s antimicrobial stewardship program went into effect in October 2013, the hospital has cut its overall antibiotic use by about 40%, saving an estimated $2 million annually, Dr. Parker reports.  

Most importantly, they continue to provide the best care for their pediatric patients, who present with a range of conditions, from pneumonia and tracheitis to osteomyelitis and otitis media. With pharmacist advice, Children’s Colorado physicians choose the most suitable antibiotic for each infection, opt for less powerful and less expensive alternatives when possible, and practice “watch and wait” when the situation calls for it. And they get to communicate face-to-face instead of relying solely on electronic medical records or phone calls. 

“Being able to explain things like antibiotic coverage and differences in dosing based on pharmacokinetics … elevates that pharmacy expertise in a way that I think is more digested and internalized by the providers. I think it helps relationships all the way around. I learn something every single day, and I think the pharmacists do too. And that makes patient care better all the way around.”

Dr. Parker’s team keeps track of their “great catches” as they work to correct issues with antibiotic dosing, toxicity, bug-drug mismatches, and even diagnostic errors. Sometimes, a catch turns into a system-wide quality improvement project and an academic study. For example, her team improved protocols for prescribing fluoroquinolones, which pose unique concerns for children. 

“It’s great to see that what you’re doing is going to make a difference … for the whole nation. That’s a really exciting thing for our pharmacists to be able to do.” 

The longer Dr. Parker practices handshake antimicrobial stewardship, the more she notices the traditional hospital “hierarchy” fading away, making room for more collegial relationships among members of the healthcare team. 

I learn something every single day, and I think the pharmacists do too. And that makes patient care better all the way around.”

“The medical profession has grown up with a bit of a hierarchy, with physicians towards the top. And as medicine has become more advanced, there’s no way providers can keep up on everything. There’s no way they’re going to have the drug expertise that a pharmacist does. It takes all of us to take good care of a patient.” 

Providing the best patient care, keeping an eye on safety, forming strong peer relationships: From this physician’s perspective, that’s what it means to be your pharmacist.