4/26/2017 Jump Start Stewardship Implementing Antimicrobial Stewardship in Small, Rural Hospitals Welcome • Thank you for your time today • This webinar will be recorded for your convenience • A copy of today ’ s presentation and the webinar recording will be available on the ABS Collaborative website and will a link will be emailed following the presentation • This is intended to be an interactive discussion please ask questions and use the chat box throughout the presentation 1
4/26/2017 Agenda • Review of CDC Core Elements • Overview of Jump Start Stewardship Workbook • Current State Assessment • Identifying Stakeholders and Team Members • Next Steps and Homework • Upcoming Educational Opportunities CDC Core Elements 2
4/26/2017 CDC Core Elements Inpatient Outpatient • Leadership • Action Commitment • Commitment • Accountability • Education/Expertise • Drug Expertise • Tracking and Reporting • Action • Tracking • Reporting • Education Core Elements • Dedicating necessary human, financial and information technology resources A written statement of support from leadership that supports efforts to o improve antibiotic use (antibiotic stewardship) • Appointing a single leader responsible for program outcomes Appoint an ABS leader (physician leader has proven most effective) o • Appointing a single pharmacist leader responsible for working to improve antibiotic use Appoint an ABS pharmacy leader o • Implement policies and interventions to improve antibiotic use Implement at least one recommended action o 3
4/26/2017 Core Elements • Monitor and report antibiotic use and outcomes Track and report antibiotic prescribing and resistance patterns to relevant o staff (process and outcome measures) • Provide regular updates on antibiotic prescribing, resistance and infectious disease management Education to clinicians and other relevant staff on improving antibiotic use o Jump Start Stewardship Implementing Antimicrobial Stewardship in Small, Rural Hospitals 4
4/26/2017 Jump Start Workbook This workbook was prepared by Qualis Health for the EQuIP Program. The EQuIP program is a joint partnership between Qualis Health (the Washington and Idaho QIN-QIO), Washington State Department of Health, Washington State Hospital Association (WSHA), and local chapters of the Association for Professionals in Infection Control (APIC). Purpose: provide guidance and tools for a framework and strategic plan for implementing a feasible, small-scale stewardship program tailored to the hospital ’ s specific needs. 5
4/26/2017 Current State Assessment • Assessment of the present activities, resources and structures of your hospital MDRO Rates o Core Elements in Place o Infectious Clinical Syndrome Profile o Antibiotic-Use Profile o 6
4/26/2017 Core Elements of Antibiotic Stewardship March 2017 Survey Data (40 CAH, 11 PPS) • Leadership Support 63% of CAHs, 73% of PPS o • Physician Leader 65% of CAHs, 100% of PPS o • Pharmacist Leader 75% of CAHs, 100% of PPS o • Action Treatment guidelines: 25% of CAHs, 100% of PPS o Policy to document in EHR: 18% of CAHs, 18% of PPS o • Education 20% of CAHs, 90% of PPS o • Tracking and Reporting 10-28% of CAHs, 20-40% of PPS o 7
4/26/2017 Infectious Clinical Syndrome Profile Antibiotic-Use Profile 8
4/26/2017 Identifying Stakeholders and Team Members • Identify Key Stakeholders for your ABS Plan • Building your Stewardship Team and Resources Tabs 5 – 9 in the workbook o Stakeholder Identification 9
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4/26/2017 Team Identification Worksheet How many hours What needs of this person per week are What will be this person ’ Potential Team s role in What are the anticipated ASP activities this person will have to be met for him/ anticipated for Member ASP? be accountable for? her to serve effectively as ASP activities for a team member? this person? Provide ASP team facilitation and act as Help create ASP project scope, plan and tasks. Schedule and lead meetings, ASP Project Administrative Lead administrative lead follow up on action items and document ASP project documents. Implement recommended actions as identified by the ASP team and provide training to staff. Confirm adherence to ASP policies and procedures, Share leadership with physician. Act as pharmacist collaborate with the ASP team to identify and provide optimal antimicrobial lead, facilitate communication and cooperation Physician therapy. Work with Pharmacist on appropriateness of orders, report with other members of the medical staff and presumptive HAIs to Infection Prevention for further surveillance and/or leadership for ASP team investigation. Accountability for antimicrobials ordered for infectious organisms within the order for the medication. Evaluate all antibiotic orders for appropriateness of therapy, if not optimal, contact the physician to modify the antimicrobial therapy unless a therapeutic change is otherwise pre-approved by hospital policy. Prior to making dosing Share leadership with pharmacist. Act as medical recommendations, the pharmacist will review all pertinent information staff lead, facilitate communication and including most recent laboratory results, renal function, other medications Clinical Pharmacist cooperation with other members of the medical staff ordered, physician notes, etc. to determine the patient ’ s overall status. The and leadership for ASP team pharmacist will document in the patient ’ s medical record any assessments, recommendations and/or changes made to the patient ’ s therapy. Review culture and sensitivity reports for inpatients daily. Recommend IV to PO conversion for antimicrobials when exclusion criteria do not exist. Focus on reducing healthcare-associated infections Monitor and review of all positive cultures for antibiotic appropriateness, (HAIs), make recommendations on interventions, discuss any discrepancies with the physician. Keep a record of all positive provide HAI performance and feedback to ASP team, cultures and antimicrobials used for identified organisms; perform Infection Preventionist and provide education to patients and visitors investigation of any possible outbreaks of infectious organisms. Collaborate about hand hygiene, contact precautions and other with the Montana DPHHS/county department of health as needed, Monitor for ways to prevent the spread of infection in the HAIs using NHSN criteria and report to the ASP team and other entities as hospital and into the community. required. Help the team interpret the hospital ’ s antibiogram to ensure that a small data Provide support and subject matter expertise to ASP set has not distorted the results and to assist in development of the most Microbiologist team and activities relevant antibiogram for the organization, definitively identify pathogens and recommend the most suitable therapy based on susceptibility data. Help leverage hospital data and systems to quickly identify at risk patients Provide support and subject matter expertise and and efficiently produce reports. Provide support to aggregate information from Information Technologist recommendations on E.H.R functionality and data various IT systems across the hospital and change clinical rules, make the opportunities that can support ASP team goals. data consolidation and analysis more seamless and enable clinicians to easily modify rules as needed. Facilitate executive buy-in and advocacy ensure the team has the budget, key ASP Program Sponsor, provide leadership to allow Senior Leader personnel and authority to succeed, set appropriate goals, prioritizing policies ASP team to be successful and monitoring program results Incorporate the ASP into the overall Quality Assessment/Performance Ensure the ASP program and initiatives follow QI Improvements program and Annual Program Evaluation. Incorporate quality methodologies and best practices, that it works well indicator data into the evaluation of the program to monitor effectiveness and Quality Improvement with other QI programs, strategies and priorities safety of services provided. Review data obtained from the program to identify and it does not overwhelm staff with the opportunities for improvement and changes that will lead to sustained simultaneous introduction of multiple new policies. improvement. Ongoing monitoring data and report data to ASP team as needed. 11
4/26/2017 Next Steps and Homework • Complete tabs 5 through 9 in the workbook Take some time to consider what works for your organization o Be prepared to discuss some of the barriers that you encountered in o sections 1 and 2 during our next webinar • Preview Section 3: Selecting Interventions and Targets for Implementation Upcoming Educational Opportunities • Jump Start Stewardship Webinar #2 May 17, 2017 1:00 – 2:00 pm o Registration: https://www.regonline.com/JumpStartStewardship2 o • Inpatient Webinar: Overview of Physician and Pharmacist Roles, responsibilities for ASP team By end of May o Registration forthcoming o • Outpatient Webinar: Overview of Physician and Pharmacist Roles, responsibilities for ASP team By end of May o Registration forthcoming o • Inpatient and Outpatient Webinar: Effective Data Tracking for ASP By end of June o Registration forthcoming o 12
4/26/2017 Questions? Casey Driscoll HIIN/STRIVE Project Director, MHA Casey.driscoll@mtha.org (406)457-8045 13
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