Antimicrobial Steward Call October 10, 2017 - TN.gov

Antimicrobial Steward CallOctober 10, 2017

Tennessee Department of HealthHealthcare Associated Infections and Antimicrobial Resistance Program

Welcome

Adobe Connect Housekeeping

US Antibiotic Awareness Week

US Antibiotic Awareness Week

• November 13–19, 2017• Mark your calendars now!

• TCPS Antimicrobial Stewardship Workgroup developing action plan for hospital promotion

• Educational and promotional materials available at CDC– https://www.cdc.gov/getsmart/week/overview.html

TDH Activities

• Governor’s proclamation• Communication via partners

– THA, TCPS, THCA, QIN-QIO, TPA

• Press release– Investigating media outlets

• TDH daily social media announcements

• Regional health department communication

• Tips for Tennesseans newsletter

Critical Access Hospitals Update

Implementing Core Elements in CAH

• “From critical access hospitals for critical access hospitals”

• Collaboration among CDC, Federal Office of Rural Health Policy, AHA, Pew Charitable Trusts

• Implementation of the core elements is now a REQUIRED quality measure for CAH who participate in the Flex grant program– ~99% of CAH

https://www.cdc.gov/getsmart/healthcare/pdfs/core-elements-small-critical.pdf

Antibiotic Use Reporting

255 bed facility 200+ physicians 18,000+ admissions per year  Flagship for a group of facilities including Marshall Medical Center in Lewisburg, Wayne Medical Center in Waynesboro, Lewis Health Center in Hohenwald, Maury Regional Spring Hill and Spring Hill Health Center in Spring Hill

MRMC Antibiotic Stewardship Program (ASP) established 9/2014

Antibiotic Stewardship Team Leader ‐ Infectious Diseases PharmD  MD champions –Infectious Diseases physician, neonatology MD, General Surgeon Infection Control

ASP is based on CDC/ Joint Commission recommendations

Clinical surveillance software

Antibiotic Use reporting since August 2015 Antibiotic Resistance reporting since February 2017

Why report?1. Powerful Antibiotic Stewardship tool2. Antibiotic Stewardship progress monitoring and reporting is required by Joint Commission

3.Will eventually become mandatory anyway

13

Hospital leadership Clinical surveillance software vendor (optional) IT Pharmacist/ Hospital IT team ID pharmacist (or person who will be responsible to AUR submission) Infection control

14

Add new users (ask Infection Control) Register with the Centers for Disease Control and Prevention’s (CDC) Secure Access Management System (SAMS) and submit documentation for identity proofing

Receive SAMS card

15

Hospital IT to ensure administration (eMAR) data is transmitted to the vendor 

The vendor   Utilizes eMAR data to automatically prepare an extract of AU data that aligns with NHSN’s current criteria

Provides NHSN Direct AU import services enabling hospital to submit that data to NHSN

AUR data is submitted monthly The pharmacist in charge of AU submissions has the option to review the data before submitting into NHSN

Obtain NHSN access

~ 2 month

Chose vendor, negotiations

1 month

Vendor sets up reporting, 

troubleshooting

5 months

Monitoring/ reporting Antibiotic Stewardship progress 

Antimicrobials used in adult ICUs and wards

Monitoring/ reporting Antibiotic Stewardship progress 

Antimicrobial Utilization Rates NICU. Rate per 1,000 Day Present

Neonatal Sepsis Protocol Implemented

Identify areas for improvement

Antibiotics used for Community onset infections in ICU

Antibiotics used for multi‐drug resistant infections in ICU

20

Asolva, Inc.  Atlas Development Corporation  MedMinded™ services from BD  Cerner  Epic Systems Corporation  Baxter Healthcare/ICNet Ilum Health Solutions  Bluebird IMS Incoporated Midas Healthy Analytics Solutions ‐Conduent RL Solutions  Sentri7 by Wolters Kluwer  TheraDoc – Premier  Truven Health Analytics  QC Pathfinder –VecnaTechnologies  VigiLanzCorporation  More information ‐ Society of Infectious Diseases Pharmacists 

(SIDP) http://www.sidp.org/aurvendors

21

What we learned: Patience! Takes longer that you may expect Multiple re‐submissions until all errors are fixed If planning moving units/ reassigning areas of the hospital best to do all changes before starting this project The website is not user‐friendly  E‐mail help/ assistance with NHSN [email protected]

Antimicrobial Stewardship Gap

Analysis

Special Thanks

• To those who have participated in our Antimicrobial Stewardship Validation and Intervention Project

• Over 100 responses have been received• >80% response rate

• Analysis pending • Results on a later call

One size doesn’t fit all: Overcoming barriers to antimicrobial stewardship in resource-limited areas

Michael P. Veve, PharmDAssistant Professor/Infectious Diseases SpecialistUniversity of Tennessee Health Science CenterKnoxville, TNE-mail: [email protected]

• Antimicrobial stewardship programs (ASP) improve patient outcomes▫ CDC Core Elements for inpatient hospitals

• Few ASP data available in resource-limited settings▫ Many challenges to implementation

Antimicrobial Resistance: A Rising Threat

CDC Core Elements, 2013; Stenehjem E et al. Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions. Clin Infect Dis. 2017. Tiong JJL et al. Front Microbiol. 2016

Leadership Commitment

Drug Expertise Tracking Education

CDC Core Elements for Stewardship

Accountability Action Reporting

US Hospitals Achieving Core Elements48% (2015)

Antibiotic Stewardship: Optimizing Antibiotic Use in the Inpatient Settings. M Neuhauser, 2017; 2016 Core Element Achievement. C Evans, 2017.

TN Hospitals Achieving Core Elements67% (2016)

• Data suggest we are doing alright, but what about the barriers?▫ Urban▫ Rural▫ Developing-countries

• National Quality Forum’s (NQF) Playbook: Antibiotic Stewardship in Acute Care

Malla et al. BMC Public Health. 2014; Stenehjem E et al. Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions. Clin Infect Dis. 2017; National Quality Forum Playbook. 2016.

“Achieving” the CDC Core Elements

• To identify and address specific gaps to successful implementation of the CDC Core Elements in resource-limited settings

Purpose

Significance• Better describe barriers to ASP in a multitude of

settings

Survey Distribution to:

• Making A Difference in Infectious Diseases (MAD-ID) Research Network

• Other infectious diseases organizations

• Developing Countries▫ Nepal, Argentina, Columbia, India

Study Participants

Study Objectives

Core Element Compliance

Identify/Classify ASP Barriers, compare and

contrast

Global/Public Health ASP Resources

Address Gaps to CDC

Core Elements

• Categorize survey respondents as Rural/Urban using ZIP code data ▫ Developing Countries- International Monetary

Fund

• Utilize targeted questions towards barriers modified from NQF Playbook

Methods

Example Assessment Questions

• Survey distributed to ASP on Core Elements▫ Abbreviated TN Survey focused on Barriers

• Development ASP best practice recommendations to overcome barriers in resource-limited settings▫ Focus Group of experts in respective areas

Future Directions & Your Participation

One size doesn’t fit all: Overcoming barriers to antimicrobial stewardship in resource-limited areas

Michael P. Veve, PharmDAssistant Professor/Infectious Diseases SpecialistUniversity of Tennessee Health Science CenterKnoxville, TNE-mail: [email protected]

Next Steps

• Next Call– December 12, 2017 at 2pm Eastern/1pm Central Time– Topic – PCN Allergy Assessment and Skin Testing

• Opportunities for involvement– Speaker or Topic for future call– Engagement with Gap Analysis Project

• Feedback always appreciated– [email protected]