Community Antibiotic Stewardship Hot Topic: Community Approach to - - PowerPoint PPT Presentation

Community Antibiotic Stewardship – Hot Topic: Community Approach to Antibiotic Awareness Week

• What type of facility are you

working with?

• Nursing Home/Home Health
• Outpatient Care Providers/Emergency Dept.
• Pharmacy
• Public Health (ex. health department)

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Polling Question

Meet Our Team

Kansas Nadyne Hagmeier, RN Nebraska Jackie Trojan, RN, BSN, CPHQ North Dakota Jean Roland, RN, BSN, CPHQ South Dakota Cheri Fast, RN, BSN, WOCN North Dakota Jayme Steig, PharmD, RPh

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Stephan Schroeder, MD Medical Director, Great Plains Quality Innovation Network

Our Speaker

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What is Antibiotic Stewardship?

• Antibiotic stewardship is the effort to:
• Measure antibiotic prescribing
• Improve antibiotic prescribing so that

antibiotics are only prescribed and used when needed

• Minimize misdiagnoses or delayed diagnoses

leading to underuse of antibiotics

• Ensure that the right drug, dose, and

duration are selected when an antibiotic is needed

It’s about patient safety and delivering high-quality healthcare.

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Why Antibiotic Stewardship in Outpatient Settings?

• High levels of antibiotic use
• Majority of human antibiotic use occurs in outpatients
• 30% of outpatient antibiotic prescriptions are unnecessary
• 50% of antibiotics for acute respiratory conditions are

unnecessary

• It’s a matter of patient safety
• Side effects from antibiotics lead to an estimated 143,000

emergency department visits per year

• Antibiotic treatment is the most important risk factor for

Clostridium difficile infection

• Inappropriate antibiotic use is primary modifiable driver of

antibiotic resistance

Shehab N, et al. Clin Infect Dis 2008;47:735–43. Gonzales R et al. Clin Infect Dis 2001;33:757–62. Suda et al. J Antimicrob Chemother 2013; 68: 715–718 Fleming-Dutra KE et al. JAMA 2016;315:1864–73 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/362374/ESPAUR_Report_2014__3_.pdf. https://www.folkhalsomyndigheten.se/pagefiles/20281/Swedres-Svarm-2014-14027.pdf.

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CDC Core Elements for Antibiotic Stewardship for Hospitals, Outpatient Facilities, and Nursing Homes.

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Initial Steps for Antibiotic Stewardship

Condition Category Example(s) Antibiotics are overprescribed Acute uncomplicated bronchitis Overdiagnosed Group A Streptococcal pharyngitis Wrong dose, duration or agent Azithromycin for sinusitis Watchful waiting or delayed prescribing is underused Acute otitis media in children Antibiotics are underused Sepsis or sexually transmitted infections

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Initial Steps for Antibiotic Stewardship

This should include antibiotic justification in medical records.

Why is the Emergency Department a target site for stewardship?

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*Each year 10 million antibiotic prescriptions are written from the ED *Unnecessary antibiotics are frequently prescribed for known viral infections.

• 75% of adults with acute bronchitis
• 45% of children with viral URI

*Inappropriate antibiotics are frequent

• 66% for UTI

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How can health professionals help?

Physicians, PA’s, Dentists, Nurses, Pharmacists, etc.

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• Prevent infections by ensuring that your hands, instruments and environments are

clean and safe for use.

• Keep patient vaccinations up to date
• Talk to patients about antibiotic resistance and dangers of unnecessary use
• Only prescribe and dispense when they are truly needed.
• Prescribe/dispense according to current guidelines, use rapid diagnostics
• Always follow infection prevention and control protocols
• Talk to patients about preventing infections (good hygiene, vaccinations, safe sex,

covering mouth and nose when sneezing)

• Screen mothers and babies for infections
• Advise on advantages of breastfeeding
• Educate patients on antibiotics, make sure they are taking right dose, right time,

best route, and side effects to report.

• Develop standards and guidelines (such as nurse driven catheter removal)

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How do we educate consumers and patients?

• Educate patients regarding medication safety. Encourage never sharing or

using leftover antibiotics. Educate on potential side effects.

• Prevent infections by regularly washing hands, handling food in a safe,

clean manner, avoid close contact with sick people.

• Promote vaccinations. (Say it is time for your annual flu shot, not do you

want your flu shot?)

• Share messages on Social Media, Twitter, Facebook, websites and use

hashtag #AntibioiticResistance or #AntibioticStewardship

• Education in waiting rooms, short videos in lobbies, brochures
• Letters to parents, flyers in elevators, posters in exam rooms
• Table tents in cafeterias, lobbies, and shopping malls
• Newspaper and radio spots
• Speak at local organizations and clubs

How can managers help?

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• By ensuring that staff clean their hands, that instruments and

environments are clean and safe for use.

• Implement programs to monitor prescribing and resistance patterns
• Dedicate resources (financial, IT) to tackling antibiotic resistance and

preventing the spread of infections

• Discharge patients as soon as they are well enough to lower the risk
• f infection
• Add antibiotic stewardship to job descriptions and allow employees

time to work on projects.

Regardless of the clinical setting, the

• verarching goal is:

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To promote adherence to clinical practice guidelines, to provide the best standard of care and minimize the spread of antibiotic resistant bacteria.

Community collaboration can happen by everyone working together!

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*Physician Clinics *Emergency Departments *Long Term Care *Home Health *Pharmacies *Urgent Care *Public Health Department *State Department of Health *Rural Health Care Clinics *Dentists, Veterinaries, Ag producers *Schools, Colleges, Universities

Questions?

Steve Schroeder, MD CMD

Stephan.Schroeder@area-a.hcqis.org

www.greatplainsqin.org

This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human

• Services. The contents presented do not necessarily reflect CMS policy. 11SOW-GPQIN-SD-C3.10-213-0417

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CDC Resources

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https://www.cdc.gov/antibiotic-use/week/index.html

Activity Ideas

• Highlight U.S. Antibiotic Awareness Week on your website
• Use U.S. Antibiotic Awareness Week as a kickoff to begin a stewardship program
• Collaborate with CDC and local-level programs on projects
• Exchange in-kind services with CDC and local-level programs
• Provide assistance to local-level programs in producing educational materials or sponsoring events
• Issue a press release
• Distribute educational materials to the general public
• Distribute tools and guidelines to healthcare professionals and facilities
• Host a local event
• Deliver presentations to interested parties
• Post social media messages and participate in the annual Twitter chat
• Share information with your organization’s membership through e-mail or newsletters
• Include print materials or information in Explanation of Benefits statements
• Promote placement of matte articles in local media
• Place ads in local or national media (free standing inserts, print ads, television or radio ads, etc.)
• Include content in employee education materials
• Distribute materials at medical conferences and exhibits
• Develop a local government proclamation

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https://www.cdc.gov/antibiotic-use/week/activities-events.html

Create a Quiz…

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Web Posts

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Press Release

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Thunderclap

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http://greatplainsqin.org/blog/join-apics-antibiotic-resistant-thunderclap/

Social Media Messaging

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Antibiotics can’t help colds, runny noses, the flu, or most sore throats because they are typically caused by viruses. However, relief is possible! Find tips for soothing symptoms caused by viral respiratory infections. Antibiotic resistance is one of the world’s most pressing public health

• problems. Think you know the facts

about antibiotics and antibiotic resistance? Test your knowledge, take CDC’s quiz. Twitter: @greatplainsqin Facebook: @GPQIN

Partner Opportunities

• The CDC will release partner tools November 13th

watch their website…

• Provide educational materials to patients & residents
• Distribute tools and guidelines to healthcare professionals
• Develop local-level appropriate antibiotic use campaigns and

coalitions

• Providing assistance to local programs in producing educational

materials or sponsoring events

• Deliver presentations to local groups
• Posting social media messages via Facebook or Twitter
• Include print materials or information in admission/discharge packets
• Promoting placement of matte articles in local print media
• Including content in employee educational materials
• Distribute materials at medical conferences and exhibits

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https://www.cdc.gov/antibiotic-use/week/partners/index.html

Promotional Materials

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https://www.cdc.gov/antibiotic-use/week/promotional-materials/index.html

Great Plains QIN Support

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What are you thinking…? What are you doing? Now is the time to share!

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To unmute your line, press #6 to ask a question! *6 will mute your line again.

Contact Information

Kansas Nadyne Hagmeier, RN nadyne.hagmeier@area-a.hcqis.org 785-273-2552 x 374 Nebraska Jackie Trojan, RN, BSN, CPHQ jackie.trojan@area-a.hcqis.org 402-476-1399 x 531 North Dakota Jean Roland, RN, BSN, CPHQ jean.roland@area-a.hcqis.org 701-989-6227 South Dakota Cheri Fast, RN, BSN, WOCN cheri.fast@area-a.hcqis.org 605-354-2553

This material was prepared the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-GPQIN-KS-C3.10-21/1017