The AHRQ Safety Program for Improving Antibiotic Use

Presenter— Pranita Tamma • Pranita D. Tamma, MD, MHS • Title: Assistant Professor of Pediatrics; Director of the Pediatric Antimicrobial Stewardship Program • Place of work: Johns Hopkins Hospital • Program email address: antibioticsafety@norc. org 2

What is the AHRQ Safety Program? • Collaborative intervention – AHRQ – Johns Hopkins Medicine – NORC • Overarching goal: – To improve antibiotic prescribing practices and assist facilities with implementing effective antibiotic stewardship programs. • The goals of antibiotic stewardship: – To ensure that all patients requiring antibiotics receive the right drug at the right dose and for the right duration. 3

What does the AHRQ Safety Program Address? • Addresses both: – Technical aspects • e. g. , best practice in antibiotic prescribing for common infectious diseases syndromes – Adaptive aspects • e. g. , safety culture, behavior change, teamwork and communication 4

Participating in the AHRQ Safety Program • One year program begins in December 2017 • No fee to participate • Entire hospitals are invited to participate but individual units within hospitals can also still participate • Facilities with and without existing ASPs are welcome to join • CME and CE available for physicians and pharmacists 5

Benefits of Participating • Access to Antibiotic Stewardship experts for coaching and troubleshooting • Monthly interactive webinars – 60 minutes long – Recorded and posted to the project website for 24/7 access – Slides and facilitator guides available for local use • Coaching calls – Optional calls for additional assistance – Twice a month 6

More Benefits of Participating • Access to: – One page documents and narrated presentations – Tools to improve antibiotic prescribing practices – Educational material for patients and families – Materials to assist with compliance with The Joint Commission Stewardship Standard 7

Expected Outcomes of Participation • Improve safety culture around antibiotic prescribing • Enhance teamwork and communication among health care workers and between health care workers and patients/families • Reduce unnecessary antibiotic use • Improve antibiotic decision-making by frontline staff • Reduce Clostridium difficile infection rates • Improve compliance with The Joint Commission Antimicrobial Stewardship Standard 8

The Four Moments of Antibiotic Decision-Making 1. Does my patient have an infection that requires antibiotics? 2. Have I ordered appropriate cultures before starting antibiotics? What empiric therapy should I initiate? 3. A day or more has passed. Can I stop antibiotics? Can I narrow therapy or change from IV to oral therapy? 4. What duration of antibiotic therapy is needed for my patient's diagnosis? 9

Acute Care Facilities Webinars: Technical Topics Antibiotic stewardship program development Best practices in the diagnosis and management of asymptomatic bacteriuria and urinary tract infections Best practices in the diagnosis and management of community-acquired lower respiratory tract conditions Best practices in the diagnosis and management of hospital-acquired and ventilator-associated pneumonia Best practices in the diagnosis and management of skin and soft tissue infections Best practices in the diagnosis and management of intra-abdominal infections Best practices in the diagnosis and management of sepsis and bacteremia Best practices in the diagnosis and management of C. difficile infections 10

Acute Care Facilities Webinars: Adaptive Topics Behavior change theory for antibiotic stewardship leaders Improving antibiotic use is a patient safety issue Improving communication and teamwork around antibiotic prescribing Identifying defects to improve antibiotic use Improving antibiotic use by learning from defects Sustaining antibiotic stewardship efforts 11

Data Required From Participating Hospitals • Monthly data on days of antibiotic therapy per 1, 000 patient days for antibiotics commonly used in the inpatient setting • Quarterly C. difficile laboratory events per 10, 000 patient-days 13

Other Data Required From Participating Hospitals • Completion of: ⁻ 10 antibiotic review forms per month per unit to identify targets for and track improvement in antibiotic prescribing • Completed by: • ASP and front-line prescribers together • Completion guide available • About 5 minutes per form 14

Team Antibiotic Review Form 14

Other Data Required From Participants • Completion of a one-page survey regarding current antibiotic stewardship practice – Basic information about the facility and current activities in patient safety and antibiotic stewardship • Completion of the Hospital Survey on Patient Safety 16

What Do Participating Hospitals Need to Do? • Identify the antibiotic stewardship team • Identify and engage front-line staff on participating units and services • Participate in monthly webinars with experts • Between webinars, identify antibiotic-related defects and identify solutions, incorporate relevant tools into practice • Submit requested data to the program website 17

Timeline for Participation Action Due Date Complete the Hospital Letter of Commitment November 17, 2017 Assemble ASP and front-line teams within your hospital November 17, 2017 Complete the Data Use Agreement (Optional) November 17, 2017 Register your team members to use the project data portal November 17, 2017 At least one team member attends an online informational webinar October 2017 Participate in monthly webinars Beginning December 2017 Regularly meet as a team to implement interventions and monitor performance December 2017 until the end of project Complete survey assessments and submit hospital data according to the data collection schedule Starting December 2017 until end of project 18

To Learn More and Enroll • Visit our website https: //safetyprogram 4 antibioticstewardship. org/ • Complete the online application on the website • Email antibioticsafety@norc. org with any questions 18

Questions 1. Type in your questions using “Chat” or 2. Speak up on conference line THANK YOU FOR PARTICIPATING! 19