IHI Expedition. Antibiotic Stewardship Session 2: Promoting a Culture for Optimal Antibiotic Use. April 3, Diane Jacobsen, MPH Loria Pollack, MD

Transcription

1 April 3, 2014 These presenters have nothing to disclose IHI Expedition Antibiotic Stewardship Session 2: Promoting a Culture for Optimal Antibiotic Use Diane Jacobsen, MPH Loria Pollack, MD

2 Today s Host 2 Sarah Konstantino, Project Assistant, Institute for Healthcare Improvement (IHI), assists in programming activities for expeditions, as well as maintaining Passport memberships, mentor hospital relations and collaboratives. Sarah is currently in the Co-Operative Education Program at Northeastern University in Boston, MA, where she majors in Business Administration with a concentration in Management and Health Science. She enjoys cooking, traveling, and fitness.

3 Audio Broadcast 3 You will see a box in the top left hand corner labeled Audio broadcast. If you are able to listen to the program using the speakers on your computer, you have connected successfully.

4 Phone Connection (Preferred) 4 To join by phone: 1) Click the button on the right hand side of the screen. 2) A pop-up box will appear with call in information. 3) Please dial the phone number, the event number and your attendee ID to connect correctly.

5 Audio Broadcast vs. Phone Connection 5 If you using the audio broadcast (through your computer) you will not be able to speak during the WebEx to ask question. All questions will need to come through the chat. If you are using the phone connection (through your telephone) you will be able to raise your hand, be unmuted, and ask questions during the session. Phone connection is preferred if you have access to a phone.

6 WebEx Quick Reference 6 Welcome to today s session! Please use chat to All Participants for questions For technology issues only, please chat to Host WebEx Technical Support: Dial-in Info: Communicate / Join Teleconference (in menu) Raise your hand Select Chat recipient Enter Text

7 When Chatting 7 Please send your message to All Participants

8 Expedition Director 8 Diane Jacobsen, MPH, CPHQ, Director, Institute for Healthcare Improvement (IHI) is currently directing the CDC/IHI Antibiotic Stewardship Initiative, NSLIJ/IHI Reducing Sepsis Mortality Collaborative. Ms. Jacobsen served as IHI content lead and improvement advisor for the California Healthcare-Associated Infection Prevention Initiative (CHAIPI) and directed Expeditions on Antibiotic Stewardship, Preventing CA-UTIs, Reducing C.difficle Infections, Sepsis, Stroke Care and Patient Flow. She served as faculty for IHI s 100,000 Lives and 5 Million Lives Campaign and directed improvement collaboratives on Sepsis Mortality, Patient Flow, Surgical Complications, Reducing Hospital Mortality Rates (HSMR) and co-directed IHI s Spread Initiative. She is an epidemiologist with experience in quality improvement, risk management, and infection control in specialty, academic, and community hospitals. A graduate of the University of Wisconsin, she earned her master s degree in Public Health- Epidemiology.

9 Today s Agenda 9 Introductions Debrief: Action Period Assignment Promoting a Culture for Optimal Antibiotic Use Action Period Assignment

10 Expedition Objectives 10 At the end of this Expedition, participants will be able to: Describe the impact of overuse and misuse of antibiotics on costs of care, antimicrobial resistance and patient complications, including Clostridium difficile. Establish a multidisciplinary focus to embed antibiotic stewardship into the process of care. Identify and begin improving at least one key process to optimize antibiotic selection, dose, and duration of antibiotics in the patient care setting.

11 Schedule of Calls 11 Session 1 Making the Case for Antibiotic Stewardship Date: Thursday, March 20 th 2:30 PM 4:00 PM ET Session 2 Promoting a Culture for Optimal Antibiotic Use Date: Thursday, April 3, 3:00 4:00 PM ET Session 3 Our Learning Journey: IHI & CDC Partnership Date: Thursday, April 17, 3:00 4:00 PM ET Session 4 Embedding Stewardship Processes into Care Delivery Date: Thursday, May 1, 3:00 4:00 PM ET Session 5 Focus on: 72 Hour Antibiotic Time-out Date: Thursday, May 15, 3:00 4:00 PM ET Session 6 What Are We Testing & Learning? Date: Thursday, May 29, 3:00 4:00 PM ET

12 Ground Rules 12 We learn from one another All teach, all learn Why reinvent the wheel? Steal shamelessly This is a transparent learning environment Share Openly All ideas/feedback are welcome and encouraged!

13 Action Period Assignment 13 Review the seven core elements and identify areas of strength and areas of opportunity. Identify one specific intervention to focus on during the expedition Identify a group of people/providers that you re not currently engaging with that you will create a partnership with to support stewardship

14 Core Elements for Antibiotic Stewardship Programs Leadership commitment from administration Single leader responsible for outcomes Single pharmacy leader Specific improvement interventions Antibiotic use tracking Regular reporting on antibiotic use and resistance Educating providers on use and resistance

15 Action Period Assignment 15 One specific intervention you plan to focus on during the expedition related to one of the Core Elements - Use the Chat Box to share - If you re connected by phone, raise your hand to discuss

16 Action Period Assignment 16 Identify the group of people/providers that you re not currently engaging with that you plan to create a partnership with to support stewardship - Use the Chat Box to share: who? what unit? what discipline? (hospitalists, pharmacists, microbiology, infection prevention, leadership) - If you re connected by phone, raise your hand to discuss

17 Faculty 17 Lori A. Loria Pollack, MD is a U.S. Public Health Service Medical Officer in the Division of Healthcare Quality Promotion (DHQP) at Centers for Disease Control and Prevention (CDC) in Atlanta, GA. Dr. Pollack received degrees in medicine and public health (MD, MPH) from UMDNJ-Robert Wood Johnson Medical School in 1999 and completed an internal medicine residency at Columbia University s primary care program in Cooperstown, NY. She joined CDC in 2002 as an Epidemic Intelligence Service Officer. Dr. Pollack was an epidemiologist in the Division of Cancer Prevention and Control where she led national efforts related to cancer survivorship. After 8 years at the federal level, she transitioned to work with the medical director of the local public health department in Atlanta, Georgia where she completed a second residency in Preventive Medicine. In July 2012, Dr. Pollack returned to CDC to focus on preventing healthcare-associated illness and addressing antibiotic resistance through antimicrobial stewardship. Dr. Pollack is board-certified in Internal Medicine and Preventive Medicine. She is the author or coauthor on more than 35 papers in epidemiology and health service research. A driving theme in Dr. Pollack s diverse public health career is the translation and dissemination of research into practical guidance and tools improve health and health care.

18 Promoting a Culture of Optimal Antibiotic Use IHI Expedition: Antibiotic Stewardship Loria Pollack, MD, MPH Division of Healthcare Quality Promotion Centers for Disease Control and Prevention April 3, 2014 National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

19 Learning Points Engaging physicians Making teams work Moving ideas into practice

20 Antibiotic Stewardship Strategic efforts to optimize antibiotic prescribing Multidisciplinary Organizational approach Facility-specific

21 Core Elements of Hospital Antibiotic Stewardship Programs Leadership Commitment Accountability Drug Expertise Action Tracking Reporting Education

22 Core Elements of Hospital Antibiotic Stewardship Programs Leadership Commitment Accountability Drug Expertise Action Tracking Reporting Education

23 Antibiotic Stewardship Leadership The art of getting someone to do something because he or she wants to do it Culture A set of shared attitudes, values, goals, and practices that characterize an organization

24 ENGAGING PHYSICIANS

25 Engaging Clinicians 2007 IHI White Paper Framework for physician involvement in quality improvement

26 Discover Common Purpose Improve patient outcomes through reduced C. difficile infections Adverse effects related to antibiotics Antibiotic resistance leads to higher mortality

27 Reframe Values and Beliefs Promote both system and individual responsibility for quality improvement System Prescribing is an act within a system Successful approaches reach beyond the prescriber Individuals The responsibility to optimize antibiotic use relies on individuals

28 Segment the Engagement Plan Use the 20/80 rule Identify and activate champions Educate and inform structural leaders

29 Ways to Improve Engagement Standardize what is standardizable Generate light, not heat, with data Make the right thing easy to try, and Easy to do

30 Adopt an Engaging Style Involve physicians from the beginning Make physician involvement visible Communicate candidly, often

31 MAKING TEAMS WORK

32 Antimicrobial Stewardship Multidisciplinary Team Infection Preventionists Risk assessment and prevention planning skills Collect, analyze and report antibiotic-related data Laboratory Input into specimen collection and proper use of relevant tests Review information flow of results to clinicians Create and interpret a facility antibiotic resistance report Nursing Review medications as part of their routine duties Could contribute through prompting discussions of antibiotic treatment, indication, and duration Information Technology (IT) Create ways integrate guidelines and policies with decision support at point of care Track antibiotic use through medication administration records

33 Making Teams Works Clear, common vision Stewardship and improve use are ambiguous Need to identify specific, measurable goals Clarify member skills and responsibilities What value does each member bring? What role can their discipline have in improving practice?

34 Growing a Team Willingness to explore ideas Use disagreement constructively Share success, learn from failure Accomplishments reinforce efforts Problem-solving builds purpose

35 MOVING IDEAS INTO PRACTICE

36 Diffusion of Innovations Theory Everett Rogers rural sociologist (1962) Factors that impact spread of new ideas and changes in practice Four elements Idea (Innovation) Process of adopting the idea Time Social system

37 Diffusion of Innovations Five stages of adoption of a new idea or practice Factors influencing adoption Knowledge Persuasion Decision Implementation Confirmation Fit with existing values and practice Simplicity Ease of use Ability to try and experiment Visible results Rogers E. (1962, 1983) Diffusion of Innovations. NY: Free Press

38 Categories of Adopters Innovators Diffusion of Innovations Early adopters Early majority Late majority Laggards Rogers E. (1962, 1983) Diffusion of Innovations. NY: Free Press. Graphic: Wikipedia

39 Diffusion of Innovations Applied to Antibiotic Stewardship Knowledge through education Persuasion through antimicrobial policies Decision and implementation of ideas by choosing activities based on factors that influence adoption Confirmation through tracking and reporting Support dissemination of successful practices Moving from early adopters to early then late majority Highlighted words are core elements of stewardship program

40 Core Elements of Hospital Antibiotic Stewardship Programs Leadership Commitment Accountability Drug Expertise Action Tracking Reporting Education

41 Summary Successful antibiotic stewardship programs depend on leadership and culture Key factors that promote a culture of optimal antibiotic use are: Engaging physicians Energizing a team Understanding factors that influence the adoption of new practices

42 Thank you Loria Pollack, MD, MPH CDC/Division of Healthcare Quality and Promotion Phone: (404) For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

43 Questions? 43 Raise your hand Use the Chat

44 Action Period Assignment 44 Based on today s discussion and feedback from other participants: Refine/Re-focus one specific intervention to focus on during the expedition Test one idea for Promoting a Culture for Optimal Antibiotic Use with the group of people/providers you identified to create a partnership with to support stewardship Come prepared to share your plans at the next session

45 Expedition Communications 45 Listserv for session communications: To add colleagues, us at Pose questions, share resources, discuss barriers or successes

46 Next Session 46 Thursday, April 17 th, 3:00 PM 4:00 PM ET Session 3 Our Learning Journey: IHI & CDC Partnership Arjun Srinivasan MD Centers for Disease Control and Prevention Scott A. Flanders, MD, MHM Jeff Rohde, MD University of Michigan