The AHRQ Safety Program for Improving Antibiotic Use

Presenter — Pranita Tamma • Pranita Tamma, M. D. , M. H. S. • Assistant Professor of Pediatrics • Director of Pediatric Antimicrobial Stewardship, 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 is the AHRQ Safety Program? • 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

What is the AHRQ Safety Program? • One year program begins in December 2017 – Three month baseline period – Nine month intervention period • No fee to participate • Entire hospitals are invited to participate but individual units within hospitals can also still participate 5

Benefits of Participating • Access to Antibiotic Stewardship experts for coaching and troubleshooting • Monthly interactive webinars – 30 -60 minutes long – Recorded and posted to the project website for 24/7 access – Slides and facilitator guides available for local use 6

Benefits of Participating • Access to: – Fast fact sheets and learning modules – 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: 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 10

Acute Care Facilities Webinars: Technical Topics Antibiotic stewardship program development Stewardship of asymptomatic bacteriuria and urinary tract infections Stewardship of community-acquired lower respiratory tract conditions Stewardship of healthcare-associated and ventilatorassociated pneumonia Stewardship of skin and soft tissue infections Stewardship of intra-abdominal infections Stewardship of C. difficile infections 11

Compliments CMS HIIN Initiative • One of the goals of the CMS’s Partnership for Patient’s Hospital Improvement Innovation Network (HIIN) initiative is reduction in C. difficile rates reported to the CDC • Adoption of antibiotic stewardship is one approach suggested to achieve this • The AHRQ Safety Program can help your site develop or improve your stewardship activities and places specific emphasis on approaches to reduce C. difficile Lab. ID events and C. difficile infection 12

Data Required From Participating Hospitals • Monthly data on days of antibiotic therapy per 1, 000 days present ← AUR measure • Using NHSN AUR definitions https: //www. cdc. gov/nhsn/pdfs/pscman ual/11 pscaurcurrent. pdf • Quarterly C. difficile laboratory events per 10, 000 patient-days 12

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 13

Team Antibiotic Review Form 15

Data Required From Participating Hospitals • Completion of a 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 14

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 16

Timeline for Participation Action Due Date Complete the Hospital Letter of Commitment October 15, 2017 Assemble ASP and front-line teams within your hospital October 15, 2017 Complete the Data Use Agreement (Optional) October 31, 2017 Register your team members to use the project data portal October 31, 2017 At least one team member attends an online informational webinar November 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 17

To Learn More and Enroll • Visit our website at https: //safetyprogram 4 antibioticstewardship. org/ • Complete the online application on the website • Email antibioticsafety@norc. org with any questions 19

Questions 1. Type in your questions using “Chat” or 2. Speak up on conference line THANK YOU FOR PARTICIPATING! 20

Joint Commission Antimicrobial Stewardship Standard 8 Required Components 1. AS established as an organizational priority 2. Education of staff and licensed independent practitioners on antibiotic use and stewardship 3. Education of patients and families 4. AS program in place consisting of an ID physician, pharmacist(s), Infection Preventionist(s), and Practitioner (depending on availability) 5. AS program includes CDC core elements 6. AS program uses organization-approved multidisciplinary protocols 7. Hospital collects, analyzes, and reports data on its ASP 8. Hospital takes action on improvement opportunities identified by its ASP 21