Journey to a Successful Antibiotic Stewardship Program in a Small Rural Healthcare Facility Please make sure to dial into the phone line: 888-895-6448 Passcode: 519-6001 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 CMSQINC22017111240.
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
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
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
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
Grand Rounds Education/Intro Stress Urgency Make a Splash Provide data and facts Identify the problem Provide the Why? 6
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
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
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
Gathering Baseline Data Systemic Psudomonas 10
Systemic MRSA Gathering Baseline Data 11
E. Coli Urine Gathering Baseline Data 12
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
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
Developing Protocols 15
Grand Rounds and Presentations Employee Portal Flyers Peer to Peer Education Staff Education Targeted education based on performance 16
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
Inpatient Prescribing Rate 18
Inpatient Cost 19
Inpatient Sepsis 20
Outpatient Bronchitis 21
Algorithms Education Data Collection Continue or Retire Measures? Target weak areas Documentation Reassessment 22
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
Pro-Calcitonin testing PCN Allergy testing Staff Certifications What s Next? 24
Dr. Erik St. Pierre MD Questions? Emergency Department Director erik.stpierre@nmmc.org Dustin Butler PharmD Pharmacy Supervisor dustin.butler@nmmc.org 25
Contact Information CONNECTICUT Francis Kissi fkissi@qualidigm.org 860.990.6534 MASSACHUSETTS Alyssa DaCunha adacunha@healthcentricadvisors.org 877.904.0057 x3241 MAINE Amanda Gagnon agagnon@healthcentricadvisors.org 207.406.3977 NEW HAMPSHIRE Margaret Crowley mcrowley@qualidigm.org 603.573.0333 RHODE ISLAND Maureen Marsella mmarsella@healthcentricadvisors.org 401.528.3223 VERMONT Regina-Anne Cooper rcooper@qualidigm.org 802.522.9413 27
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