Jump Start Stewardship Implementing Antimicrobial Stewardship in - - PDF document

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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

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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

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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

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CDC Core Elements

Inpatient Outpatient

Leadership

Commitment

Accountability
Drug Expertise
Action
Tracking
Reporting
Education
Action
Commitment
Education/Expertise
Tracking and Reporting

Core Elements

Dedicating necessary human, financial and

information technology resources

A written statement of support from leadership that supports efforts to

improve antibiotic use (antibiotic stewardship)

Appointing a single leader responsible for program
utcomes
Appoint an ABS leader (physician leader has proven most effective)
Appointing a single pharmacist leader responsible

for working to improve antibiotic use

Appoint an ABS pharmacy leader
Implement policies and interventions to improve

antibiotic use

Implement at least one recommended action

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Core Elements

Monitor and report antibiotic use and outcomes
Track and report antibiotic prescribing and resistance patterns to relevant

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

Jump Start Stewardship

Implementing Antimicrobial Stewardship in Small, Rural Hospitals

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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

f 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.

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Current State Assessment

Assessment of the present activities, resources and

structures of your hospital

MDRO Rates
Core Elements in Place
Infectious Clinical Syndrome Profile
Antibiotic-Use Profile

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Core Elements of Antibiotic Stewardship

March 2017 Survey Data (40 CAH, 11 PPS)

Leadership Support
63% of CAHs, 73% of PPS
Physician Leader
65% of CAHs, 100% of PPS
Pharmacist Leader
75% of CAHs, 100% of PPS
Action
Treatment guidelines: 25% of CAHs, 100% of PPS
Policy to document in EHR: 18% of CAHs, 18% of PPS
Education
20% of CAHs, 90% of PPS
Tracking and Reporting
10-28% of CAHs, 20-40% of PPS

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Infectious Clinical Syndrome Profile Antibiotic-Use Profile

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Identifying Stakeholders and Team Members

Identify Key Stakeholders for your ABS Plan
Building your Stewardship Team and Resources
Tabs 5 – 9 in the workbook

Stakeholder Identification

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Potential Team Member What will be this person’ s role in ASP? What are the anticipated ASP activities this person will be accountable for? How many hours per week are anticipated for ASP activities for this person? What needs of this person have to be met for him/ her to serve effectively as a team member? ASP Project Administrative Lead Provide ASP team facilitation and act as administrative lead Help create ASP project scope, plan and tasks. Schedule and lead meetings, follow up on action items and document ASP project documents. Physician Share leadership with physician. Act as pharmacist lead, facilitate communication and cooperation with other members of the medical staff and leadership for ASP team Implement recommended actions as identified by the ASP team and provide training to staff. Confirm adherence to ASP policies and procedures, collaborate with the ASP team to identify and provide optimal antimicrobial

therapy. Work with Pharmacist on appropriateness of orders, report

presumptive HAIs to Infection Prevention for further surveillance and/or

investigation. Accountability for antimicrobials ordered for infectious
rganisms within the order for the medication.

Clinical Pharmacist Share leadership with pharmacist. Act as medical staff lead, facilitate communication and cooperation with other members of the medical staff and leadership for ASP team 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 recommendations, the pharmacist will review all pertinent information including most recent laboratory results, renal function, other medications

rdered, physician notes, etc. to determine the patient’s overall status. The

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. Infection Preventionist Focus on reducing healthcare-associated infections (HAIs), make recommendations on interventions, provide HAI performance and feedback to ASP team, and provide education to patients and visitors about hand hygiene, contact precautions and other ways to prevent the spread of infection in the hospital and into the community. Monitor and review of all positive cultures for antibiotic appropriateness, discuss any discrepancies with the physician. Keep a record of all positive cultures and antimicrobials used for identified organisms; perform investigation of any possible outbreaks of infectious organisms. Collaborate with the Montana DPHHS/county department of health as needed, Monitor for HAIs using NHSN criteria and report to the ASP team and other entities as required. Microbiologist Provide support and subject matter expertise to ASP team and activities Help the team interpret the hospital’s antibiogram to ensure that a small data set has not distorted the results and to assist in development of the most relevant antibiogram for the organization, definitively identify pathogens and recommend the most suitable therapy based on susceptibility data. Information Technologist Provide support and subject matter expertise and recommendations on E.H.R functionality and data

pportunities that can support ASP team goals.

Help leverage hospital data and systems to quickly identify at risk patients and efficiently produce reports. Provide support to aggregate information from various IT systems across the hospital and change clinical rules, make the data consolidation and analysis more seamless and enable clinicians to easily modify rules as needed. Senior Leader ASP Program Sponsor, provide leadership to allow ASP team to be successful Facilitate executive buy-in and advocacy ensure the team has the budget, key personnel and authority to succeed, set appropriate goals, prioritizing policies and monitoring program results Quality Improvement Ensure the ASP program and initiatives follow QI methodologies and best practices, that it works well with other QI programs, strategies and priorities and it does not overwhelm staff with the simultaneous introduction of multiple new policies. Incorporate the ASP into the overall Quality Assessment/Performance Improvements program and Annual Program Evaluation. Incorporate quality indicator data into the evaluation of the program to monitor effectiveness and safety of services provided. Review data obtained from the program to identify

pportunities for improvement and changes that will lead to sustained
improvement. Ongoing monitoring data and report data to ASP team as needed.

Team Identification Worksheet

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Next Steps and Homework

Complete tabs 5 through 9 in the workbook
Take some time to consider what works for your organization
Be prepared to discuss some of the barriers that you encountered in

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
Registration: https://www.regonline.com/JumpStartStewardship2
Inpatient Webinar: Overview of Physician and

Pharmacist Roles, responsibilities for ASP team

By end of May
Registration forthcoming
Outpatient Webinar: Overview of Physician and

Pharmacist Roles, responsibilities for ASP team

By end of May
Registration forthcoming
Inpatient and Outpatient Webinar: Effective Data

Tracking for ASP

By end of June
Registration forthcoming

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Questions?

Casey Driscoll HIIN/STRIVE Project Director, MHA Casey.driscoll@mtha.org (406)457-8045