IHI Expedition Antibiotic Stewardship Session 2: Promoting a - PowerPoint PPT Presentation

April 3, 2014 These presenters have nothing to disclose IHI Expedition Antibiotic Stewardship Session 2: Promoting a Culture for Optimal Antibiotic Use Diane Jacobsen, MPH Loria Pollack, MD

Today’s Host 2 Sarah Konstantino , Project Assistant, Institute for Healthcare Improvement (IHI), assists in programming activities for expeditions, as well as maintaining Passport memberships, mentor hospital relations and collaboratives. Sarah is currently in the Co-Operative Education Program at Northeastern University in Boston, MA, where she majors in Business Administration with a concentration in Management and Health Science. She enjoys cooking, traveling, and fitness.

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8 Expedition Director 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 9 Introductions Debrief: Action Period Assignment Promoting a Culture for Optimal Antibiotic Use Action Period Assignment

10 Expedition Objectives 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.

11 Schedule of Calls 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

12 Ground Rules 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!

13 Action Period Assignment Review the seven core elements and identify areas of strength and areas of opportunity. Identify one specific intervention to focus on during the expedition Identify a group of people/providers that you’re not currently engaging with that you will create a partnership with to support stewardship

Core Elements for Antibiotic Stewardship Programs  Leadership commitment from administration  Single leader responsible for outcomes  Single pharmacy leader  Specific improvement interventions  Antibiotic use tracking  Regular reporting on antibiotic use and resistance  Educating providers on use and resistance

15 Action Period Assignment One specific intervention you plan to focus on during the expedition related to one of the Core Elements - Use the Chat Box to share - If you’re connected by phone, raise your hand to discuss

16 Action Period Assignment Identify the group of people/providers that you’re not currently engaging with that you plan to create a partnership with to support stewardship - Use the Chat Box to share: who? what unit? what discipline? (hospitalists, pharmacists, microbiology, infection prevention, leadership) - If you’re connected by phone, raise your hand to discuss

17 Faculty Lori A . ‘ Loria ’ Pollack, MD is a U.S. Public Health Service Medical Officer in the Division of Healthcare Quality Promotion (DHQP) at Centers for Disease Control and Prevention (CDC) in Atlanta, GA. Dr. Pollack received degrees in medicine and public health (MD, MPH) from UMDNJ-Robert Wood Johnson Medical School in 1999 and completed an internal medicine residency at Columbia University’s primary care program in Cooperstown, NY. She joined CDC in 2002 as an Epidemic Intelligence Service Officer. Dr. Pollack was an epidemiologist in the Division of Cancer Prevention and Control where she led national efforts related to cancer survivorship. After 8 years at the federal level, she transitioned to work with the medical director of the local public health department in Atlanta, Georgia where she completed a second residency in Preventive Medicine. In July 2012, Dr. Pollack returned to CDC to focus on preventing healthcare-associated illness and addressing antibiotic resistance through antimicrobial stewardship. Dr. Pollack is board-certified in Internal Medicine and Preventive Medicine. She is the author or coauthor on more than 35 papers in epidemiology and health service research. A driving theme in Dr. Pollack’s diverse public health career is the translation and dissemination of research into practical guidance and tools improve health and health care.

Promoting a Culture of Optimal Antibiotic Use IHI Expedition: Antibiotic Stewardship Loria Pollack, MD, MPH Division of Healthcare Quality Promotion Centers for Disease Control and Prevention April 3, 2014 National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

Learning Points  Engaging physicians  Making teams work  Moving ideas into practice

Antibiotic Stewardship  Strategic efforts to optimize antibiotic prescribing  Multidisciplinary  Organizational approach  Facility-specific

Core Elements of Hospital Antibiotic Stewardship Programs  Leadership Commitment  Accountability  Drug Expertise  Action  Tracking  Reporting  Education http://wwwdev.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf

Core Elements of Hospital Antibiotic Stewardship Programs  Leadership Commitment  Accountability  Drug Expertise  Action  Tracking  Reporting  Education http://wwwdev.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf

Antibiotic Stewardship  Leadership  The art of getting someone to do something because he or she wants to do it  Culture  A set of shared attitudes, values, goals, and practices that characterize an organization

ENGAGING PHYSICIANS

Engaging Clinicians  2007 IHI White Paper  Framework for physician involvement in quality improvement http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx

Discover Common Purpose  Improve patient outcomes through reduced  C. difficile infections  Adverse effects related to antibiotics  Antibiotic resistance leads to higher mortality

Reframe Values and Beliefs  Promote both system and individual responsibility for quality improvement System Individuals • Prescribing is an act • The responsibility to within a system optimize antibiotic use relies on individuals • Successful approaches reach beyond the prescriber http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx

Segment the Engagement Plan  Use the 20/80 rule  Identify and activate champions  Educate and inform structural leaders http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx