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

IHI Expedition

Antibiotic Stewardship Session 2: Promoting a Culture for Optimal Antibiotic Use

April 3, 2014

These presenters have nothing to disclose

Diane Jacobsen, MPH Loria Pollack, MD

Today’s Host

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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.

Audio Broadcast

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Phone Connection (Preferred)

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Expedition Director

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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

• n 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

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Introductions Debrief: Action Period Assignment Promoting a Culture for Optimal Antibiotic Use Action Period Assignment

Expedition Objectives

At the end of this Expedition, participants will be able to: Describe the impact of overuse and misuse of antibiotics

• n 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

• ptimize antibiotic selection, dose, and duration of

antibiotics in the patient care setting.

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Schedule of Calls

Session 1 – “Making the Case” for Antibiotic Stewardship Date: Thursday, March 20

th 2:30 PM – 4:00 PM ET

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

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Ground Rules

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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!

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

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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

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

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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

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Faculty

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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

• r 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.

Loria Pollack, MD, MPH

Division of Healthcare Quality Promotion Centers for Disease Control and Prevention April 3, 2014

Promoting a Culture

• f Optimal Antibiotic Use

IHI Expedition: Antibiotic Stewardship

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

http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx

System Individuals

• Prescribing is an act

within a system

• Successful

approaches reach beyond the prescriber

• The responsibility to
• ptimize antibiotic use

relies on individuals

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

Ways to Improve Engagement

 Standardize what is ‘standardizable’  Generate light, not heat, with data  Make the right thing easy to try, and

• Easy to do

http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx

Adopt an Engaging Style

 Involve physicians from the beginning  Make physician involvement visible  Communicate candidly, often

http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx

MAKING TEAMS WORK

Antimicrobial Stewardship Multidisciplinary Team

• Risk assessment and prevention planning skills
• Collect, analyze and report antibiotic-related data

Infection Preventionists

• Input into specimen collection and proper use of relevant tests
• Review information flow of results to clinicians
• Create and interpret a facility antibiotic resistance report

Laboratory

• Review medications as part of their routine duties
• Could contribute through prompting discussions of antibiotic

treatment, indication, and duration

Nursing

• Create ways integrate guidelines and policies with decision

support at point of care

• Track antibiotic use through medication administration records

Information Technology (IT)

Making Teams Works

 Clear, common vision

• Stewardship and ‘improve use’ are ambiguous
• Need to identify specific, measurable goals

 Clarify member skills and responsibilities

• What value does each member bring?
• What role can their discipline have in improving

practice?

Growing a Team

 Willingness to explore ideas  Use disagreement constructively  Share success, learn from failure

• Accomplishments reinforce efforts
• Problem-solving builds purpose

MOVING IDEAS INTO PRACTICE

Diffusion of Innovations Theory

 Everett Rogers – rural sociologist (1962)  Factors that impact spread of new ideas and

changes in practice

 Four elements

• Idea (Innovation)
• Process of adopting the idea
• Time
• Social system

• Fit with existing

values and practice

• Simplicity
• Ease of use
• Ability to try and

experiment

• Visible results

Diffusion of Innovations

Rogers E. (1962, 1983) Diffusion of Innovations. NY: Free Press

Knowledge Persuasion Decision Implementation Confirmation

Five stages of adoption

• f a new idea or practice

Factors influencing adoption

Diffusion of Innovations

Categories of Adopters

 Innovators  Early adopters  Early majority  Late majority  Laggards

Rogers E. (1962, 1983) Diffusion of Innovations. NY: Free Press. Graphic: Wikipedia

Diffusion of Innovations

Applied to Antibiotic Stewardship

 Knowledge through education  Persuasion through antimicrobial policies  Decision and implementation of ideas by choosing

activities based on factors that influence adoption

 Confirmation through tracking and reporting

• Support dissemination of successful practices
• Moving from early adopters to early then late majority

Highlighted words are core elements of stewardship program

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

Summary

 Successful antibiotic stewardship programs

depend on leadership and culture

 Key factors that promote a culture of optimal

antibiotic use are:

• Engaging physicians
• Energizing a team
• Understanding factors that influence the adoption
• f new practices

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you

Loria Pollack, MD, MPH CDC/Division of Healthcare Quality and Promotion Email: lop5@cdc.gov Phone: (404) 639-1154

National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

Questions?

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Raise your hand Use the Chat

Action Period Assignment

Based on today’s discussion and feedback from other participants: Refine/Re-focus one specific intervention to focus on during the expedition Test one idea for Promoting a Culture for Optimal Antibiotic Use with the group of people/providers you identified to create a partnership with to support stewardship Come prepared to share your plans at the next session

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Expedition Communications

Listserv for session communications: ABSExpedition@ls.ihi.org To add colleagues, email us at info@ihi.org Pose questions, share resources, discuss barriers or successes

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Next Session

Thursday, April 17th, 3:00 PM – 4:00 PM ET

Session 3 – Our Learning Journey: IHI & CDC Partnership

Arjun Srinivasan MD Centers for Disease Control and Prevention Scott A. Flanders, MD, MHM Jeff Rohde, MD University of Michigan

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