3/19/2014 March 20, 2014 These presenters have nothing to disclose IHI Expedition Antibiotic Stewardship Session 1 Diane Jacobsen, MPH Scott Flanders, MD Arjun Srinivasan, MD Expedition Coordinator 2 Kayla DeVincentis, CHES, Project Coordinator, Institute for Healthcare Improvement, currently manages web-based Expeditions and the Executive Quality Leaders Network. She began her career at IHI in the event planning department and has since contributed to the State Action on Avoidable Rehospitalizations (STAAR) Initiative, the Summer Immersion Program, and IHI’s efforts for Medicare-Medicaid enrollees. Kayla leads IHI’s Wellness Initiative and has designed numerous activities, challenges, and educational opportunities to improve the health of her fellow staff members. In addition to implementing the organization’s first employee health risk assessment, Kayla is certified in health education and program planning. Kayla is a graduate of Northeastern University in Boston, MA, where she obtained her Bachelors of Science in Health Science with a concentration in Business Administration. 1
3/19/2014 WebEx Quick Reference 3 Welcome to today’s • session! Raise your hand Please use chat to “All • Participants” for questions For technology issues only, • please chat to “Host” WebEx Technical Support: • 866-569-3239 Dial-in Info: Communicate / • Join Teleconference (in Select Chat recipient menu) Enter Text When Chatting… 4 Please send your message to All Participants 2
3/19/2014 Chat Time! 5 What is your goal for participating in this Expedition? 5 6 Join Passport to: Get unlimited access to Expeditions , two- to four-month, • interactive, web-based programs designed to help front- line teams make rapid improvements . Train your middle managers to effectively lead quality • improvement initiatives. . . . and much, much more for $5,000 per year! Visit www.IHI.org/passport for details. To enroll, call 617-301-4800 or email improvementmap@ihi.org. 3
3/19/2014 IHI Open School Courses 7 More than 20 online courses developed by world- renowned experts in the following topics Improvement Capability – Patient Safety – Person- and Family-Centered Care – Triple Aim for Populations – Quality, Cost, and Value – Leadership – More than 26 continuing education contact hours for nurses, physicians, and pharmacists. NAHQ has also approved the courses for CPHQ CE credit. Basic Certificate of Completion available upon completion of 16 foundational course. Mobile App for iPhone and iPad 20% Discount on organizational subscription for Passport Members What is an Expedition? 8 ex • pe • di • tion (noun) 1. an excursion, journey, or voyage made for some specific purpose 2. the group of persons engaged in such an activity 3. promptness or speed in accomplishing something 4
3/19/2014 Expedition Support 9 All sessions are recorded Materials are sent one day in advance Listserv address for session communications: ABSExpedition@ls.ihi.org – To add colleagues, email us at info@ihi.org Where are you joining from? 5
3/19/2014 Expedition Director 11 Diane Jacobsen, MPH, CPHQ, Director, Institute for Healthcare Improvement (IHI) is currently directing the CDC/IHI Antibiotic Stewardship Initiative, NSLIJ/IHI Reducing Sepsis Mortality Collaborative. Ms. Jacobsen served as IHI content lead and improvement advisor for the California Healthcare-Associated Infection Prevention Initiative (CHAIPI) and directed Expeditions on Antibiotic Stewardship, Preventing CA-UTIs, Reducing C .difficle Infections, Sepsis, Stroke Care and Patient Flow. She served as faculty for IHI’s 100,000 Lives and 5 Million Lives Campaign and directed improvement collaboratives on Sepsis Mortality, Patient Flow, Surgical Complications, Reducing Hospital Mortality Rates (HSMR) and co-directed IHI’s Spread Initiative. She is an epidemiologist with experience in quality improvement, risk management, and infection control in specialty, academic, and community hospitals. A graduate of the University of Wisconsin, she earned her master’s degree in Public Health- Epidemiology. Today’s Agenda 12 Ground Rules & Introductions Pre-program Survey Results Making the Case for Antibiotic Stewardship Engaging Front Line Providers IHI’s Model for Improvement Action Period Assignment 6
3/19/2014 Ground Rules 13 We learn from one another – “All teach, all learn” Why reinvent the wheel? – Steal shamelessly This is a transparent learning environment – Share Openly All ideas/feedback are welcome and encouraged! 14 Overall Program Aim The Expedition will provide insights from the hospitalist-led antibiotic stewardship initiative in partnership with the Centers for Disease Control and Prevention (CDC) that incorporated specific interventions to improve antibiotic use into the process of patient care, such as an "antibiotic timeout" to facilitate/prompt de-escalation or discontinuation of antibiotics through review of AB, dose, indication and expected duration. 7
3/19/2014 Expedition Objectives 15 At the end of this Expedition, participants will be able to: Describe the impact of overuse and misuse of antibiotics on costs of care, antimicrobial resistance and patient complications, including Clostridium difficile. Establish a multidisciplinary focus to embed antibiotic stewardship into the process of care. Identify and begin improving at least one key process to optimize antibiotic selection, dose, and duration of antibiotics in the patient care setting. Schedule of Calls 16 Session 1 – “Making the Case” for Antibiotic Stewardship th 2:30 PM – 4:00 PM ET Date: Thursday, March 20 Session 2 – Promoting a Culture for Optimal Antibiotic Use Date: Thursday, April 3, 3:00 – 4:00 PM ET Session 3 – Our Learning Journey: IHI & CDC Partnership Date: Thursday, April 17, 3:00 – 4:00 PM ET Session 4 – Embedding Stewardship Processes into Care Delivery Date: Thursday, May 1, 3:00 – 4:00 PM ET Session 5 – Focus on: 72 Hour Antibiotic “Time-out” Date: Thursday, May 15, 3:00 – 4:00 PM ET Session 6 – What Are We Testing & Learning? Date: Thursday, May 29, 3:00 – 4:00 PM ET 8
3/19/2014 Pre-Program Survey Results Diane Jacobsen, MPH, CPHQ 18 Survey Results: What roles will be represented on your team participating in the Expedition? 9
3/19/2014 Survey Results: 19 Barriers to a successful Antibiotic Stewardship Program Lack of a Physician Champion C suite not recognizing the impact of ASP, MDRO’s CDI Lack of ID physicians; lack of expertise on site Limited access to pharmacy in some clinical areas Limited forum to communicate useful data to physicians Staffing: Cuts, shortages, perceived time constraints IT support; Ability to access/report useful data Culture: “We’ll need to change a lot of mindsets” Survey Results: 20 What we’re most proud of in improving Antibiotic Stewardship Developing interest [in ABS] at the management level Creation of a multidisciplinary team through the physician & chief Agreed upon formulary limiting choice of appropriate AB Review of unit based prescribing data at monthly team meetings Active role of pharmacy in monitoring & making recommendations w/input from ID specialist pharmacist Broader representation on ASP committee, including hospitalists Audited transparency of AB use at the point of care & reviewed current status to improve processes, rather than focusing on individual treatment decisions 10
3/19/2014 Survey Results: 21 What we’re hoping to learn about AB Stewardship About 72 hour AB time out How to start a stewardship program - first thing a facility should do Ideas for eliminating barriers and engaging C suite Better ways to engage/support front-level providers How others have successfully overcome barriers “Everything I need to know to pull this together successfully” Survey Results: 22 Degree to which each core element is currently in place/practice Do not know the Do no have this Have a current This element is Need further current status of element in current process that reliably applied clarification on this element practice at our supports this in all relevant this element in our hospital hospital element in our situations in our hospital hospital Leadership 15% 17% 9% 3% 56% Accountability 18 38 32 6 6 Drug Expertise 18 26 35 21 0 Prescribing 15 32 38 15 0 Improvement Track AB Use 18 26 38 15 3 Report Rx and 27 35 29 6 3 Resistance Educate 18 23 50 9 0 11
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