WEBINAR: Making the Numbers Count-Using Your Pharmacy Data to Support Antibiotic Stewardship and Infection Control New England Nursing Home Quality Care Collaborative Webinar Will Begin Shortly. Call-In Number: (888) 895-6448 Access Code: 5196001 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. CMSQINC22018021349.
CMS Rules of Participation for LTCFs; CDC Core Elements of Antibiotic Stewardship Brittany Roy, MPH New England QIN-QIO Webinar with Maine Veterans Homes February 22, 2018 Maine Center for Disease Control and Prevention 2
Phase 1 (11/28/16) Phase 2 (11/28/17) Phase 3 (11/28/19) CMS Rules of Participation - Infection Control Program - QAA Committee - Facility Assessment - Antibiotic Stewardship Program - Initial QAPI Plan - Infection Preventionist with specialized training - Full implementation of QAPI with IP integration Full, detailed document available at FederalRegister.gov Maine Center for Disease Control and Prevention 3
Phase 3: The IP Requirement per CMS RoPs Facility must designate 1 or more individuals as Infection Preventionists (IP) who are responsible for the facility Infection Prevention and Control Program (IPCP). IP must: 1. Have primary professional training in nursing, medical technology, microbiology, epidemiology or other related field; 2. Is qualified by education, training, experience, or certification; 3. Works at least part-time at the facility; 4. Has completed specialized training in Infection Prevention and Control; 5. Must be a member of facility Quality Assessment committee and report regularly on the IPCP. Maine Center for Disease Control and Prevention 4
Phase 3: IP Training per CDC ICAR Tool https://www.cdc.gov/infectioncontrol/pdf/icar/ltcf.pdf Maine Center for Disease Control and Prevention 5
Phase 3: IP Training Options http://maineinfectionpreventionforum.org/ General Infection Control training for Extended Care 8-hour course covering instructions for standard, droplet, and airborne precautions and when to use them, HH, PPE, handling of contaminated equipment/surfaces in resident environment Ask for the Go To Guide (full of links and resources) Blood Borne Pathogens (clinical and non-clinical editions) Biological Hazards Maine CDC endorsed! Maine Center for Disease Control and Prevention 6
Phase 3: IP Training Options AHCA IPCO Certification Does IPCO meet CMS requirements? Yes, IPCO meets the expectations CMS has outlined on the required components of the specialized training. CMS is not endorsing any particular training, rather CMS is focused on the content and intensity/duration of what will meet the specialized training requirement. Based on information AHCA received from CMS, the IPCO training meets both the content and intensity/duration of CMS requirements. Maine Center for Disease Control and Prevention 7
Antibiotic Use in Nursing Homes Complex patient population Comorbidities, indwelling devices Close contact with other antibioticexposed individuals in NH (horizontal transmission of resistance genes) Frequent transfer from community to hospital Inappropriate antibiotic exposure: Indication, length of therapy, spectrum Antibiotic exposure is associated with a high risk of adverse drug events Side effects and drug interactions Long-term disruption of normal flora C. difficile infection Antibiotic resistance Maine Center for Disease Control and Prevention 8
Antibiotic Resistance: A Potential Consequence of Antibiotic Use Maine Center for Disease Control and Prevention 9
Antibiotic Stewardship Phase 2 Requirement Antibiotic stewardship program that includes antibiotic use protocols and systems for monitoring antibiotic use and recording incidents identified under the facility s infection prevention and control program (IPCP) and the corrective actions taken by the facility. Maine Center for Disease Control and Prevention 10
Antibiotic Stewardship Phase 2 Requirement Infection Prevention and Control Program (IPCP) Specifically, the IPCP would: include infection prevention, identification, surveillance, and antibiotic stewardship; require each facility to periodically review and update its program; require performance of an analysis of the resident population and facility; designate an infection prevention and control officer(s) (IPCO); integrate the IPCO with the facility s quality assurance and performance improvement (QAPI) program; establish written policies and procedures for the IPCP; and provide the IPCO and facility staff with education or training related to the IPCP. Maine Center for Disease Control and Prevention 11
Core Elements for Nursing Home Antibiotic Stewardship Maine Center for Disease Control and Prevention 12
Maine Extended Care Facilities: Progress in meeting the Core Elements of Antimicrobial Stewardship 100.00% LTC Antibiotic Stewardship Core Elements Tracking - State of Maine 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Leadership Commitment Accountability Drug Expertise Action Tracking Reporting Education % Meeting all 7 criteria % Meeting Criteria 2016 % Meeting Criteria 2018 Maine Center for Disease Control and Prevention 13
Questions? Rita Owsiak MS, MT(ASCP), CIC Healthcare Associated Infections Coordinator Rita.Owsiak@maine.gov Phone: 207-287-6028 Jennifer Liao, PharmD Antibiotic Resistance Coordinator Jennifer.Liao@maine.gov Phone: 207-287-6516 Brittany Roy, MPH Healthcare Associated Infections Specialist Brittany.Roy@maine.gov Phone: 207-287-2682 Maine Center for Disease Control and Prevention 14
Making the Numbers Count: Using Your Pharmacy Data to Support Antibiotic Stewardship & Infection Control February 22, 2018
Meeting the Core Elements Leadership Support Accountability Drug Expertise Actions to Improve Use Tracking: Monitoring Antibiotic prescribing, Use and Resistance Reporting Information Education
Partnering with Pharmacy Drug expertise & infectious disease pharmacist Monitoring of antibiotic prescribing & Labs Collaboration with pharmacy, nursing & physicians Education Resources & tools Data provided by pharmacy
Working with the Data from the Clinical Perspective Monitor and identify trends & infection rates Review infection control program & practices in relation to the data Measurable Goals and defined outcomes Communication of the data Education QAPI
Pharmacy and Antibiotic Stewardship Main objective is for Pharmacy to provide support for our nursing homes utilizing our core competency of drug expertise 3 Main Elements from Pharmacy include; Help develop in-service education to staff within homes Provide objective data for continuous quality improvement Develop process to optimize antibiotic therapy for our residents
Optimization Step 1- Collect Data (run report) on daily Antibiotic Starts Step 1a- Collect Height and Weight report Step 1b- Collect lab data that includes Serum Creatinine and Culture and Sensitivities Step 2- Calculate Creatinine Clearance and Analyze labs Step 2a- Is this dose appropriate for the patients renal function? Step 2b-Analyze Culture and Sensitivity Step 2c-Communicate change in therapy when necessary Step 3- Record findings for CQI and review at QAPI
CQI Antibiotic Stewardship changes for Pharmacy Operations Pharmacist s actively monitoring medication safety and efficacy Recommending changes based upon lab results Documenting unavailable information for reporting (Serum Creatinine, C + S) Provide feedback to Senior Leadership + Corporate QAPI
The Pharmacist Role Continued Project Management Shift Pharmacists have inherent knowledge in work flow and efficiency management Antibiotic Stewardship represents a shift towards Project Management Less input and output More Problem Solving Developing systems and process for Data Mining Increase need for communication with nursing and Physicians Helping to develop treatment algorithms that integrate medications Increased opportunities for delegation
Shared Learnings from the process DATA is Crucial!!! DATA Collection often requires multiple systems and thinking outside the box DATA is Crucial!!! AND HAS THE POTENTIAL TO BECOME THE BIGGEST CHALLENGE Who is good at Excel and tech savvy within your organization?
Shared Learnings from the process The Success-Is the result of culture shift and ownership at Multiple Levels within the organization Optimization helps guide prescribing and leads to the most efficient utilization of antibiotics. It s A Journey!!
Creating a benchmark calculation A good equation to use for tracking monthly antibiotic therapy usage is the following:
Creating a benchmark calculation
Sample Graph: Number of Antibiotic Therapies
Sample Graph: Number of UTI Therapies by Facility
Sample Graph: Number of UTI Therapies by Facility
Sample Graph: Number of Infection Therapies by Facility
Sample Graph: Antibiotics dispensed over a given month
Presenters Donna Baker R.N., Manager of Clinical Systems Support, Maine Veterans Homes Antibiotic Stewardship Team Member. Email: dbaker@mainevets.org Neil A. Thurlow Pharm.D, MBA, Assistant Director, Maine Veterans Homes-MVH Pharmacies, Antibiotic Stewardship Team Member. Email: nthurlow@mainevets.org Rob Potter, CPhT, Pharmacy Business Office Manager, Antibiotic Stewardship Team Member. Email : rpotter@mainevets.org
Questions
MARK YOUR CALENDARS! Mar 13 th WEBINAR: Antimicrobial Stewardship: Strategies for Implementation Apr 3 rd WEBINAR: Infection Control: Prevention 34
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, email: learning@healthcentricadvisors.org
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QIN-QIO State Leads Connecticut Florence Johnson fjohnson@qualidigm.org Maine Danielle Watford dwatford@healthcentricadvisors.org Massachusetts Sarah Dereniuk-Dudley sdudley@healthcentricadvisors.org New Hampshire Pam Heckman Pam.heckman@area-N.hcqis.org Rhode Island Nelia Odom nodom@healthcentricadvisors.org Vermont Gail Harbour Gail.Harbour@area-N.hcqis.org