Communities of Care Antimicrobial Stewardship Collaborative 2014 Project Overview Carol Dietz RN, MBA, BSN, CPHQ.

Communities of Care Antimicrobial Stewardship Collaborative

2014 Project Overview

Carol Dietz RN, MBA, BSN, CPHQ

The Problem

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“Growing concern about antimicrobial resistance and the need for practical strategies to manage antimicrobial use effectively has reached a global scale, and demand for education, tools and expertise has increased both in the U.S. and internationally. There is a need for a multifaceted strategy to increase the number of effective antimicrobials available, to reduce resistance to available antibiotic treatments, and to put existing research on this important topic into practice.”

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Project Goal

To assist hospitals and their community partners to work together from April through July, 2014 to develop and implement antimicrobial stewardship programs based on their community-specific needs. needs.

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Participant Expectations

• Commit to appropriate antibiotic usage at your facility

• Commit to be the AMS champion in your facility

• Attend community meetings with your community partners

• Participate in monthly conference calls with Qualidigm

• Confer rights to NHSN data to Qualidigm (hospitals only)

• Complete the appropriate Antimicrobial Stewardship Environmental Scan for your facility

Participant Expectations continued…..

• Submit a copy of your facility's antibiogram to Qualidigm at kick-off session

• Collect monthly data and submit to Qualidigm for analysis

• Participate in kick-off and wrap-up collaborative

face-to-face sessions

Community Expectations

Community leader/Stewardship leader will sign the

participation agreement

Select one or two antimicrobial stewardship

interventions to be implemented and monitored in your

community

Discuss data and other related issues

at monthly community meetings

Present findings/lessons learned at the

wrap-up session

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Project Timeline

Kick-off

April, 2014

• Knowledge transfer/reinforcement• Complete AIM statement• Draft work plan

Monthly

activities

• Regular meetings with your community partners to discuss progress and opportunities Qualidigm representative will attend as a resource

• Data collection as determined by each community • Monthly conference calls with all Communities hosted by Qualidigm for peer-to-peer learning • Monthly NHSN data entry by hospitals• Technical assistance by Qualidigm as needed

Wrap-up

July, 2014

• Celebration of wins • Presentation by each participating Community

Antibiograms

• Used by clinicians (hopefully) to:– Assess local susceptibility rates– Aid in selecting empiric therapy– Monitor susceptibility and resistance trends

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AMS Program Resources

AMS Checklist (CDC) Leadership commitment: Dedicate necessary human, financial, and

IT resources. Accountability: Appoint a single leader responsible for program

outcomes; physicians have proven successful in this role. Drug expertise: Appoint a single pharmacist leader to support

improved prescribing. Act: Take at least one prescribing improvement action, such as

requiring reassessment within 48 hours to check antibiotic choice, dose, and duration (antibiotic timeout).

Track: Monitor prescribing and antibiotic resistance patterns. Report: Regularly report to staff prescribing and resistance patterns,

and steps to improve. Educate: Offer education about antibiotic resistance and improving

prescribing practices.

Breakout Session #1

Opportunity to discuss Barriers to implementing an AMS program as well as Best Practices that have been implemented as Antimicrobial Stewardship interventions.Breakout in specific settings:

– Hospital– Nursing Home– Home Health

There is a flip chart and

facilitator assigned to your

community group

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Break-out Session #2

Opportunity to kick-start your antibiotic stewardship project within your communityBreak out into your “Community of Care”

• Develop a SMART AIM statement

• Create a Work Plan

• Identify missing community members and decide how to bring

them up to speed

• Propose next meeting date to refine work plan, including those

performance measure(s) that make the most sense

• Select a spokesperson to provide progress report to group at large

SMART AIM Statement (in Handouts)

Specifi c– What is the goal or intent

Measureable– Defines the acceptance criteria against which the requirement

can be evaluated Acti onable

– The actions the team can take to overcome any known barriers to achieving the proposed measurable results

Realistic– Ensures that there are sufficient resources and time to achieve

the aim statement Timely

– The goal has a target date

Create an AIM Statement using all the elements

from your SMART outline

Develop a Work Plan

_________________ Community Antibiotic Stewardship Collaborative

Name of the recorder:____________________________________________

Email address:__________________________________________________

Introductions: facility, role, expectations

AIM statement:

Additional community members to recruit:

Project structure and design: (e.g. new community work group, existing community readmission work group, sub-committee of existing community work group, other)

Issues/opportunities (short term: “low hanging fruit”, and long term)

Performance measures: a. Hospital reported MRSA bacteremia and C. diff rates to CDC/NHSN b. Readmission rates c. Qualitative and quantitative changes in practice around management of antibiotic use

Next Steps

Action Items Responsible Party Due Date

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• Name of community• Name of recorder• Name of each facility• AIM statement• Others to recruit• How workgroup fits into

current community meeting• Short term goals• Performance measures

– Process measures– Outcome measures

• Action Items

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Sample Performance Measures

• MRSA Bacteremia rate• CDI rate• Number of antibiotics reviewed concurrently,

number of changes recommended by concurrent reviewer, number of recommended changes approved by treating MD, and resulting potential and actual cost savings

• All antibiotic orders have an indication and therapy is reassessed within 72 hours

“Measure something!”- Dale Bratzler DO

Sample Performance Measures (continued)

• Cultures obtained before antibiotics administered for sepsis or systemic inflammatory response syndrome

• Patients who can be switched from intravenous to oral antibiotics are switched

• Review of all positive blood cultures for bug/drug mismatch

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Sample Performance Measures (continued)

• Non-treatment of asymptomatic bacteriuria • Compliance with SCIP antibiotic measures• Antibiogram resistance• Defined Daily Dose of antibiotic (DDD) per 1000

patient days• Days of Therapy (DOT) per 1000 patient days

The New Model: A Spectrum of Activities

Many approaches in between

Bottom Line: Function Trumps Structure

Comprehensive program led by ID trained physician and pharmacist

Individual interventions based on goals of institution led by interested individual(s)

Community Focus Areas – Last Year

• Asymptomatic bacteriuria• Handoff communication: hospital nursing

home, HHA

Asymptomatic Bacteriuria

• Toolkit available on Qualidigm web-site http://www.qualidigm.org/index.php/current-initiatives/antimicrobial-stewardship-collaborative/asymptomatic-bacteriuria-tookit/Antibiotic

order formPoster: “Ask

me” campaign

Handout for residents and

family members

Masonicare sample

handout

Lessons Learned by Participants• Availability of tools in the public domain e.g. CDC• The significant impact of antibiotic use and serious sequellae to residents/patients• ASPs are worthwhile but challenging to get to work optimally; but any progress is

better than none• Increase use of urine dipsticks leads to increase in antibiotics. Need to eliminate use

of dipsticks, need to education MD’s, APRN’s and nursing staff. Need to include antibiotic stewardship in nursing orientation program.

• How important it is to have open communication with families and physicians• Some practical approaches to stewardship (much data on stewardship emphasizes

the “why” but not the “how” to go about it)• Multidisciplinary participation is essential• That good, data-based, evidence-based answers are being developed• Antimicrobial stewardship program represents an opportunity to improve patient

safety• I’ve learned a lot about the barriers to implementing antimicrobial stewardship

programs in health care facilities

Lessons Learned (cont.)• Decrease antibiotic use, decrease infections, increase staff/family

awareness• How important it is to decrease the use of antibiotics• Obtain lab test before treating resident• One step at a time; this has been very informative• The need to educate staff, families and residents• The need to utilize antibiograms• Commonalities among hospital systems• Don’t forget CNAs• Value of communication• Utilize other Communities of Care to assist our current program• The power of data to measure success/progress

ToolsImplementation

Strategies

Support Structure Networking

Peer-to-Peer Learning

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Questions?