Reflections on Stewardship

In Commentary, Opinion by Nadim LalaniLeave a Comment

I came across this posting from one of my fav blogs  [here’s the original link]. It made me think about stewardship. What is stewardship and why is it important?

So I did a quick lit search and came across an article from PubMed. The article talks about how to start good stewardship regarding antibiotics in the ER. In fact most of the literature seems to centre around antimicrobial stewardship.

I was reflecting on a time when [role-modeling my attendings] I learned how to write orders for “drug X” for asthma management. When I moved to a different province I learned that “drug X” is more expensive than “drug W” – and so I had thus unwittingly added costs to the system – our publicly-funded and finite-resource system.

I believe that it’s important to be good stewards for medications – in fact I preach this to my learners, but I have to admit that I don’t always consider the drug costs/cheaper alternatives. So I am unfortunately part of the problem of the exponential increase in health-care costs.

I don’t think that it’s realistic or even possible to stay 100% on top of things. But I think that we can always do better, But HOW can I go beyond saying “i need to be better at checking the cost before I write the order”?

I think that the best answers come from dialogue – so I am going to go back to my group and put this out there for discussion. I encourage all y’all to do the same. My initial ideas:

  • Consider having an educational session – enlist your colleagues who have expertise in pharmacy.
  • Use your QI people  – We’re fortunate to have our QI guy – who is better at thinking about these concepts than I am [see his interesting blog post].
  • Involve your department/hospital pharmacy personnel – The article above talks about involving the ER pharmacist directly in the culture-positive call back system We need them more involved so I am going to try and find a way to do this.
Nadim Lalani

Nadim Lalani

Nadim is an emergency physician at the South Health Campus in Calgary, Alberta. He is passionate about online learning and recently made a transition into human performance coaching. He is currently working on introducing the coaching model into medical education.