Journey to a Successful Antibiotic Stewardship Program in a Small Rural Healthcare Facility

Transcription

1 Journey to a Successful Antibiotic Stewardship Program in a Small Rural Healthcare Facility Please make sure to dial into the phone line: Passcode: This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (NE QIN-QIO), the Medicare Quality Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy CMSQINC

2 Journey to a Successful Antibiotic Stewardship Program in a Small Rural Healthcare Facility Northern Maine Medical Center November 2017 Erik St. Pierre MD Emergency Dept. Director Dustin Butler PharmD Pharmacy Supervisor 2

3 Speaker Disclosures Today s speakers have no conflicts of interest to disclose. In adherence to the regulation standards of the Connecticut Pharmacists Association, the Accreditation Council of Pharmacy Education, Northeast Multistate Division (NE-MSD) this notice confirms that the information contained in this presentation is free of commercial bias and the speakers have no related vested financial interest in any capacity, inclusion of shareholder, recipient of research grants, consulting or advisory committees. 3

4 What is it??? Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. 4

5 Objectives Make a Splash Selecting the right team members Allocating limited resources Gathering baseline data Developing standardized, evidence based protocols Staff Education Gathering Post Implementation Data Reassessment Tips and Pearls What s Next? 5

6 Grand Rounds Education/Intro Stress Urgency Make a Splash Provide data and facts Identify the problem Provide the Why? 6

7 Building Your Team Physician Leader Hospitalists, Office Providers Lead Pharmacist Trained Clinical Pharmacists SIDP Certification ID Consult Administration Lab Infection Control Nursing Quality IT Public Relations 7

8 NMMC Allocating Limited Resources 49 Bed Sole Community Hospital No ID physician/specialist Consult with larger hospital No designated FTEs for program Efficient team Clear goals and assignments at each meeting Meet monthly 8

9 Gathering Baseline Data Multi-Department Collaboration Data to Collect Resistance Data Antibiogram MRSA and C. Diff Rates Prescribing patterns Target most relevant diagnoses Usage Data DDD/patient days Adherence to required documentation Target one disease state at a time to keep it manageable Example: Inpatient-Sepsis and Outpatient-Bronchitis 9

10 Gathering Baseline Data Systemic Psudomonas 10

11 Systemic MRSA Gathering Baseline Data 11

12 E. Coli Urine Gathering Baseline Data 12

13 Gathering Baseline Data MRSA Rate: 41% Inpatient Prescribing Rate: 23% DDD/Patient Days Outpatient Bronchitis Prescribing Rate: 35% Inpatient Adherence to Sepsis Algorithm: 73% Adherence to documentation: 50% 13

14 Evidence-Based/Best Practices Tailor to formulary and antibiogram/resistance trends. Easy to follow Top diagnoses for both inpatient and outpatient settings Make available Review at least annually Developing Protocols 14

15 Developing Protocols 15

16 Grand Rounds and Presentations Employee Portal Flyers Peer to Peer Education Staff Education Targeted education based on performance 16

17 Gathering Post Implementation Data Same criteria as baseline data Multidisciplinary effort Heavy involvement from IT Use the same parameters Graph it Better to have a visual 17

18 Inpatient Prescribing Rate 18

19 Inpatient Cost 19

20 Inpatient Sepsis 20

21 Outpatient Bronchitis 21

22 Algorithms Education Data Collection Continue or Retire Measures? Target weak areas Documentation Reassessment 22

23 Bronchitis Improve specificity of diagnosis, exclude COPD patients, and exclude patient with co-occurring infections. Reinforce documentation of duration of therapy Pay attention to trends in non-adherence Possible that your algorithm may have errors or omissions? Include Antibiotic Stewardship in provider evaluations. Pay per performance measure Be persistent Tips and Pearls 23

24 Pro-Calcitonin testing PCN Allergy testing Staff Certifications What s Next? 24

25 Dr. Erik St. Pierre MD Questions? Emergency Department Director Dustin Butler PharmD Pharmacy Supervisor 25

26 Contact Information CONNECTICUT Francis Kissi MASSACHUSETTS Alyssa DaCunha x3241 MAINE Amanda Gagnon NEW HAMPSHIRE Margaret Crowley RHODE ISLAND Maureen Marsella VERMONT Regina-Anne Cooper

27 The Learning Center Captures valuable data such as: Pre and post tests Knowledge checks Surveys Learners course specific reports: Test responses Activity completions Feedback Number of Attempts Access at Learning4Quality.org Questions, comments, or concerns, 28

28 Connect with the New England QIN-QIO on Social Media! 29