Pharmacy Roundtable Implementing Antimicrobial Stewardship Programs- - - PowerPoint PPT Presentation
Pharmacy Roundtable Implementing Antimicrobial Stewardship Programs- Suggestions for Rural and Critical Access Hospitals-a Hospital Story Presenter: Jon C. Francisco, Pharm.D, BCPS Clinical Specialist Memorial Hospital Pembroke Hosted by FHA
Presenter: Jon C. Francisco, Pharm.D, BCPS Clinical Specialist Memorial Hospital Pembroke
Hosted by FHA Mission to Care HIIN Phyllis Byles, RN, BSN, MHSM, BC-NEA, FHA Clinical Performance Improvement Advisor Scott King, Pharm.D, Orlando Health Dr. P. Phillips Hospital
August 9, 2017
BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 05/17 FL Rate 3.73 2.31 2.01 3.01 2.69 2.69 2.54 2.21 1.96 HRET HIIN Rate 3.72 3.35 3.16 3.54 3.33 2.71 2.39 2.44 2.10 # FL Reporting 68 74 73 74 74 74 74 66 56 #HRET HIIN Reporting 1,145 1,221 1,225 1,223 1,247 1,245 1,207 1,105 968 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50
Rate per 100
Source: Comprehensive Data System, August 3, 2017
BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 05/17 FL Rate 6.42 2.99 2.93 3.13 2.90 2.92 3.27 3.89 3.45 HRET HIIN Rate 4.25 3.97 3.92 3.93 4.21 4.44 4.74 4.59 4.79 # FL Reporting 61 63 63 64 63 63 61 64 55 #HRET HIIN Reporting 1,090 1,162 1,167 1,168 1,190 1,184 1,150 1,073 937 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00
Rate per 100
Source: Comprehensive Data System, August 3, 2017
BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 05/17 FL Rate 0.52 0.44 0.48 0.45 0.45 0.45 0.46 0.44 0.32 HRET HIIN Rate 0.48 0.46 0.46 0.49 0.50 0.54 0.53 0.54 0.49 # FL Reporting 67 71 71 71 68 67 65 62 58 #HRET HIIN Reporting 1,115 1,178 1,185 1,182 1,196 1,190 1,155 1,067 937 0.00 0.20 0.40 0.60 0.80
Rate per 100
Source: Comprehensive Data System, August 3, 2017
BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 05/17 FL Rate 6.96 5.05 5.43 5.12 5.02 5.09 4.70 4.25 4.90 HRET HIIN Rate 6.15 6.10 6.13 5.79 6.05 5.49 5.28 5.11 5.16 # FL Reporting 90 90 90 90 90 90 90 81 80 #HRET HIIN Reporting 1,506 1,553 1,552 1,555 1,539 1,536 1,505 1,384 1,281 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00
Rate per 10,000
Source: Comprehensive Data System, August 3, 2017
BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 05/17 FL Rate 0.61 0.54 0.62 0.59 0.60 0.60 0.60 0.56 0.53 HRET HIIN Rate 0.67 0.75 0.75 0.77 0.81 0.82 0.80 0.92 0.81 # FL Reporting 88 83 84 84 86 85 85 77 68 #HRET HIIN Reporting 1,433 1,468 1,470 1,465 1,465 1,451 1,401 1,214 1,056 0.00 0.25 0.50 0.75 1.00 1.25 1.50
Rate per 1,000
Source: Comprehensive Data System, August 3, 2017
BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 FL Rate 10.07 9.93 10.07 9.85 9.87 9.83 9.67 9.69 HRET HIIN Rate 8.71 7.86 7.83 7.57 8.63 8.52 7.94 8.31 # FL Reporting 89 83 83 83 84 84 84 74 #HRET HIIN Reporting 1,413 1,435 1,436 1,466 1,378 1,264 1,122 896 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0
Rate per 100
Source: Comprehensive Data System, August 3, 2017
BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 FL Rate 13.88 13.04 13.05 12.72 12.92 12.79 12.22 12.32 HRET HIIN Rate 11.77 10.24 10.14 9.97 11.10 11.13 10.42 10.75 # FL Reporting 61 70 70 72 71 71 70 63 #HRET HIIN Reporting 1,061 1,276 1,274 1,307 1,218 1,108 973 771 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0
Rate per 100
Source: Comprehensive Data System, August 3, 2017
J O N C . F R A N C I S C O P H A R M D , B C P S
Community hospital with 301 licensed beds located
in Pembroke Pines, Florida
MHP is part of the South Broward Hospital District.
It is one of the six hospitals of the Memorial Healthcare System
MHP serves a diverse population, ranging from
different levels of acuity
Effective January 1, 2017 The TJC standard has 8 elements of performance
Numerous available tools and resources
ASP efforts must be clearly documented to reflect:
Documentation of policies/procedures Documentation of training and data/quality
EP 1– requires hospital leadership to
establish antimicrobial stewardship as a priority
Leadership commitment and accountability Strategic plan Resources dedicated for ASP
EP 1
Strategic plan
Formal written statement that administration places ASP as
an organizational priority
Contains model for ASP team, core ASP practices and
principles of performance improvement
Developed based on TJC, CDC Core Measures, and
Leapfrog standards
Resources dedicated for ASP
Human Financial Technology
Develop and advance the “business case” to show an
ASP provides high value by :
Designate a physician in the C-suite or individual
that reports to C-suite accountable for program
Integrate ASP activities into ongoing quality
improvement and/or patient safety efforts in the hospital
i.e. Sepsis, C. Diff
Create reporting structure that ensures information
leadership and administration
CMS related reports
Seeking off-site support for ASP efforts
Enrolling in multi-hospital collaboration
State hospital associations or local public
Large academic medical centers
Including ASP services in contracts for external
EP 2 requires hospital staff and licensed
independent practitioners to be educated in antimicrobial stewardship
All staff responsible for ordering, dispensing or
administering antimicrobials or monitoring the program must receive education upon hire
Upon the granting of privileges and periodically as
determined by the hospital
EP 2
All Staff
Competencies
Health/Skills Fairs Nursing
Orientation
Meetings Physicians
Committees and Meetings
Education
Physician Orientation
Rounds
Lounge Pharmacy
Competencies
ASP training
EP 3 requires patients and families to be
Patient Education TigrTV
Inpatient Medication Education Family/ Caregiver Education Discharge Education
Antibiotic information /material
Follow-up Callback
EP 4 requires the hospital to establish
multidisciplinary antimicrobial stewardship team
Lead Infectious Disease Physician overseeing system ASP
System ASP Steering Committee
Chief Medical Officer of each site leads local ASP
Nursing Pharmacy Infection Control
*Extrapolated from MHS ASP Steering Committee Documents
Physician Champion Internal Medicine/Hospitalists Nursing Representatives
Nursing Leadership ER Critical Care Outpatient
Pharmacy Representatives Infection Control Quality/Clinical Effectiveness Education
Review proper culture techniques Review culture results with providers Monitoring antibiotic response with feedback Assess opportunities to convert to PO antibiotics Education Initiating “antibiotic time-outs” with clinicians
EP 5 outlines core elements that should be
Core elements designed to help hospitals define the keys
to drive their programs and helps document expectations
Includes plan of recommended actions
EP 6 requires hospitals to have
Policies and procedures
Antibiotic Formulary restrictions IV to PO/Pharmacokinetics Guidelines/Ordersets
Protocols should be based on the hospital’s population
and experience
Protocols should take into account common infections
EP 6 requires hospitals to have
Policies and procedures
Antibiotic Formulary restrictions IV to PO/Pharmacokinetics Guidelines/Ordersets
Protocols should be based on the hospital’s population
and experience
Protocols should take into account common infections
*Extrapolated from MHS ASP Steering Committee Documents
*Extrapolated from MHS ASP Steering Committee Documents
*Extrapolated from MHS ASP Steering Committee Documents
Restricted broad spectrum antibiotics Prospective Audit and Feedback Mandatory Indication and Duration Facility Specific Treatment Guidelines
Broad Interventions
Automatic IV to PO conversion Dose adjustment for organ dysfunction Dose Optimization/ Pharmacokinetics Clinical Decision Support Systems
Pharmacy Driven Interventions
Should serve as the foundation of a
Advantages and Disadvantages Requires leadership support and allocated
Dedicated Pharmacokinetic Monitoring and Adjustment
Program
Continuous quality improvement and assessment
Increase Use of Oral Antibiotics as a Strategy to Improve
Outcomes
IV to PO protocol Initial therapy Non oral equivalent IV antibiotic recommendations
Interventions to Reduce Antibiotic Therapy to the Shortest
Effective Duration
Facility guidelines/order sets with preset durations Integrated in preauthorization or PAF process Specifying duration at the time of order
High Yield Majority of all antibiotic use
Focus on three Syndrome Specific Conditions:
Community Acquired Pneumonia Urinary Tract Infections Skin and Soft Tissue Infections
Focus on specific key agents
Determination driven by provider discussions Maximized when reviewed after 2 - 3 days of therapy initiation
EP 7 requires hospitals to collect and analyze data
as part of its stewardship program
EP 8 requires hospitals to take action on
improvement opportunities, based in part on that data
doing to act on it
Antibiogram
rates
Antibiotics administered to patients per day DOT (Days of therapy) Direct expenditure for antibiotics Purchasing cost
Annual Antibiogram distributed to prescribers with easy access of Antibiogram on workstations Prescribers receive direct, personalized communication on improving antibiotic prescribing Facility-specific reports on antibiotic use with prescribers Data reported to local and system site ASP and appropriate committees Evaluate data and identify opportunities for improvement and optimization
DOT/DDD alternatives Monitoring adherence to facility-specific
Monitoring performance of antibiotic time outs
Performing MUE for selected antibiotics IV to PO services evaluation and missed
CDC threat report Top relevant facility specific pathogens
Summary of ASP activities ASP team design Preliminary Data Future plans
Expanding outpatient services Continue educating providers in the community
Participation through CME
Continue collaborating with physicians with
ID and ER
Memorial Healthcare System Antimicrobial Stewardship Program
The Joint Commission. Antimicrobial Stewardship. Accessed March 20, 2017. https://www.jointcommission.org/topics/hai_antimicrobial_stewardship.aspx
Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. Accessed March 20, 2017. http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
The Joint Commission. New Antimicrobial Stewardship Standard. Accessed March 20, 2017. https://www.jointcommission.org/assets/1/6/New_Antimicrobial_Stewardship_Standa rd.pdf
Centers for Disease Control and Prevention. Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals. Accessed July 16, 2017. http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
Barlam TF, Cosgrove SE, et. al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for implementing an antibiotic stewardship program. Clinical Infectious Diseases: an official publication of the Infectious Diseases Society of America. 2016; DOI: 10.1093/cid/ciw118
National Quality Forum. National Quality Partners Playbook: Antibiotic Stewardship in Acute Care. Accessed July 16, 2017. http://www.qualityforum.org/Publications/2016/05/National_Quality_Partners_Playbo
JFrancisco@mhs.net
CDI CAUTI SSI VAE CLABSI Sepsis
Scrub: for 20 seconds with the right product. Remember soap for C.diff.
Own: your role in preventing HAIs.
Address: immediately intervene if breach is observed.
Place: hand hygiene products in strategic locations.
Update: hand hygiene products and policies as needed to promote adherence.
Protect: patient and families, get them involved.
Injuries / 1-2 PM ET
Orlando
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