Welcome. Infection Prevention in Long Term Care: Implementing the New Rules 3/22/2017

Transcription

1 Infection Prevention in Long Term Care: Implementing the New Rules Spring Education Conference March 29, 2017 Prairie Meadows Conference Center Altoona, IA Day 2, Session 6 Welcome 2 1

2 For Today Basic overview of the new CMS rules and regulations for Infection Prevention and Control in LTC Starting an Antibiotic Stewardship Program Interventions for the Antibiotic Stewardship Program (focusing on UTIs) How to Approach the Facility Assessment: F Tag Why this matters now? Residents admitted with higher medical acuity Co morbidities of frail and elderly Nature of close living increases risks Protection of residents and staff No longer just a hospital issue but a community issue 4 2

3 New Rules and Regulations for Infection Prevention in LTC Infections and communicable diseases Organized program that follows national guidelines Antibiotic Stewardship Immunization Policies Education of Staff 5 Walk this way Infections and communicable diseases Organized program that follows national guidelines Antibiotic Stewardship Immunization Policies Education of Staff 6 3

4 New Rules and Regulations for Infection Prevention in LTC Infection Preventionist Primary professional in nursing, medical technology, microbiology, epidemiology, or other related field Qualified by education, training, experience, or certification Works at least part time at the facility Completed specialized training in infection prevention and control Reports & Participates on Quality Assurance & Performance Improvement Committee Annual review of program Facility risk assessment 7 Stand up if 8 4

5 Antibiotic Stewardship Program Are all on board? Leadership support is crucial: 1) Administration 2) Medical Director 3) Pharmacy Consultant 4) Director of Nursing 5) Lab Consultant 6) Infection Prevention Coordinator 9 This looks kind of familiar QAPI Steering Committee A group who has a vested interest in the outcome Who should be on it? Administrator, DON, MDS, Medical Director, Pharmacist, department heads What do they do? Guide the PIP teams Develop goals Remove barriers Provide resources 10 5

6 But how.!?! Establish agenda, meeting format, minutes and communication to all staff Help establish priorities Measurable objectives Data collection 11 Antibiotic Stewardship Programs Choosing a Program There are several programs available for long term care facilities that are very basic to the more complex Centers for Disease Control (CDC): The Core Elements of Antibiotic Stewardship for Nursing Homes (September 2015)** 12 6

7 Antibiotic Stewardship Programs Minnesota Department of Health: Minnesota Antimicrobial Stewardship Program Toolkit for Longterm Care Facilities The Michigan Antibiotic Resistance Reduction Coalition (MARR) Long term Care Toolkit Greater New York Hospital Association/United Hospital Fund: Antimicrobial Stewardship Toolkit Public Health Ontario: Antimicrobial Stewardship 13 Antibiotic Stewardship Program CDC Core Elements Leadership Commitment Accountability Drug Expertise Action Tracking Reporting Education Core Elements 14 Center for Disease Control: The Core 7

8 This looks kind of familiar Leadership Commitment Steering Committee Accountability Steering Committee Drug Expertise Steering Committee Action Performance Improvement Project (PIP) Team Tracking PIP Team Reporting PIP Team & Steering Committee Education All 15 Antibiotic Stewardship Program CDC Core Elements Multidisciplinary Collaboration Goals Policies Interventions for Antibiotic Use Core Elements 16 Center for Disease Control: The Core 8

9 So does this. Multidisciplinary Collaboration Steering Committee Goals SMART Goal from Steering Committee Policies Steering Committee and PIP Team Interventions for Antibiotic Use PIP Team 17 National Healthcare Safety Network (NHSN) For C.Difficile Web based tracking and reporting Lab ID event reporting In Iowa, Telligen has 66+ facilities recruited to report 18 The Center for Disease Control: The Core Elements of Antibiotic Stewardship for Nursing Homes 9

10 State Rate= 5.4% Nat l Rate= 4.1% 19 What do we do first? Gather more data Schedule Antimicrobial Stewardship Steering Committee Develop a SMART goal Identify PIP team Review current policy for 20 10

11 PIP Team Identify team Schedule meeting or huddle time Outline goals, timeline What s the Plan? Hint PDSA and RCA 21 Interventions for UTIs Beginner UTI Timeout (watchful waiting) SBAR improve nurse and medical provider communication Wait for lab report, choose narrow spectrum antibiotic Do not test for cure of UTIs or C Diff 22 11

12 Tools 23 McGeer Criteria 24 12

13 Interventions Advanced Formulary restrictions or preauthorization Antibiotic order Antibiotic 3 day stop IV to oral antibiotic conversion as soon as possible No antibiotic orders for asymptomatic bacteriuria or colonization 25 The Center for Disease Control: The Core Common Sense Use antibiotics for the shortest time possible Discourage prophylaxis for prevention of UTIs Discourage routine irrigation 26 The Center for Disease Control: The Core 13

14 Tracking and Data Collection Antibiogram Track multidrug resistant organisms & C Diff McGeer s Criteria for LTC Infection Surveillance Guidelines and Clinical Pathways 27 Products Theraworx Conveen Leg Bag Duette Catheter UTI Stat 28 14

15 Antibiotic Stewardship Program Interventions: Metric Definitions DOT Days of Therapy Rate of DOT (DOT/total monthly resident days X 1000) Antibiotic Starts (number of new antibiotic starts/total resident days X 1000) AUR Antibiotic Utilization Rates (total monthly DOT/total monthly resident days) Prevalence Data percentage of resident s receiving antibiotic 29 How to Approach the Facility Assessment: F tag 409 Overall goal: the facility must conduct and document a facility wide assessment to determine what resources are necessary to care for its residents competently during both day to day operations and emergencies. The facility must review and update that assessment, as necessary, and at least annually. The facility must also review and update this assessment whenever there is, or the facility plans for, any change that would require a substantial modification to any part of this assessment

16 How to Approach the Facility Assessment: F tag 409 F tag (e) A facility must include as part of its infection prevention and control program mandatory training that includes the written standards, policies, and procedures for the program 31 How to Approach the Facility Assessment: F tag 490 Infection prevention & control piece includes: 1. Infection prevention & control staffing 2. Purpose of the infection prevention and control office 3. Surveillance 4.Infection prevention and control policies, procedure, protocols 5. Vaccination program pneumonia and influenza vaccines 6. Infection Prevention & Control Committee 7. Antimicrobial Stewardship Committee 8. Committees served on, especially QAPI 9. Education provided to employees and residents 32 16

17 How to include residents and families Share information with them Signage in room Care conferences Bulletin board Include them in care Hand washing Educate staff Share data Include front line staff on PIP teams Consistent messaging

18 Antibiotic Stewardship Program Questions? 35 Contact Information Chris Barten, RN, BSN Infection Prevention and Control Officer Iowa Veterans Home Central Iowa APIC District Consultant Gov Kate LaFollette, RN Program Specialist, Telligen d.hcqis.org 36 18