Acute Care Onboarding Call 1 Presenter Sara Cosgrove Sara Cosgrove MD MS Title Professor of Medicine Division of Infectious Diseases Director Antimicrobial Stewardship Program Associate Hospital Epidemiologist ID: 753624
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AHRQ Safety Program for Improving Antibiotic Use
Acute Care: Onboarding Call #1 Slide2
Presenter: Sara Cosgrove
Sara Cosgrove, MD, MSTitle: Professor of Medicine, Division of Infectious Diseases, Director, Antimicrobial Stewardship Program, Associate Hospital Epidemiologist
Place of work: Johns Hopkins HospitalProgram email address:antibioticsafety@jhmi.edu
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Housekeeping
Keep phone on mute
Use ‘raise hand’ or ‘chat’ feature in WebEx if you need to speak
Hold off most questions until the end during Q&A
Participate when asked
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Objectives of Onboarding Call #1
Understand the goals of the
AHRQ Safety Program
for Improving Antibiotic Use
Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program
Understand the timeline and components of the acute care educational toolkit
Learn the objectives and timeline for the AHRQ Safety Program
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Goals of the Program
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AHRQ Safety Program for Improving Antibiotic Use
A quality improvement collaborative to improve antibiotic use across healthcareProgram targets 3 settingsAcute CareLong-term Care
Ambulatory CareEducational content includes:
Clinical (evidence-based approaches)
Cultural interventions (CUSP)
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Integrating Two Important Concepts
Technical Training Adaptive Training
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Expected Outcomes of Program
Improved safety culture
Enhanced teamwork and communication
Reduction in suboptimal antibiotic usage
Improved antibiotic decision-making
Reduction in
Clostridium difficile
infections
Improved provider, patient,
and family satisfaction
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Benefits to Participants
Technical assistance for Antibiotic Stewardship programsAccess to CUSP (and teaching/coaching webinars)Networking on regional and national levelsCompliance with The Joint Commission Antimicrobial Stewardship Standard
Access to a comprehensive toolkit
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Objectives
Understand the goals of the
AHRQ Safety Program
for Improving Antibiotic Use
Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program
Understand the timeline and components of the acute care educational toolkit
Learn the objectives and timeline for the AHRQ Safety Program
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The Joint Commission
Antimicrobial Stewardship Standard
Antibiotic Stewardship established as an organizational priority
Education of staff and licensed independent practitioners on antibiotic use and stewardship
Education of patients and families
Antibiotic Stewardship program in place consisting of an Infectious Diseases physician, pharmacist, infection
preventionist
, prescriber
Antibiotic Stewardship program includes CDC core elements
8 Required Components
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6. AS program uses of organization-approved multidisciplinary protocols
Guidelines for antibiotic use Re-evaluation of and feedback to providers regarding antibiotic prescriptions
Antibiotic time out7. Hospital collects, analyzes, and reports data on its ASP
8. Hospital takes action on improvement opportunities identified by its ASP
8 Required Components
The Joint Commission
Antimicrobial Stewardship Standard
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Objectives
Understand the goals of the
AHRQ Safety Program
for Improving Antibiotic Use
Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program
Understand the timeline and components of the acute care educational toolkit
Learn the objectives and timeline for the AHRQ Safety Program
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Educational Toolkit
A series of technical and adaptive eLearning modules that will be reviewed via webinars.
Webinars will be held 1-2 times per month.
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Participant Overview
With existing AS programs, there will be 3 levels of participants—Antibiotic Stewardship teamUnit champions (e.g., physician, pharmacist, and nurse lead)
Frontline staff
WithOUT
existing AS programs, the institution should identify physician and pharmacist leadership to form the backbone of the stewardship team
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Objectives
Understand the goals of the
AHRQ Safety Program
for Improving Antibiotic Use
Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program
Understand the timeline and components of the acute care educational toolkit
Learn the objectives and timeline for the AHRQ Safety Program
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Onboarding Call #2
Antibiotic Stewardship TeamApril 2017
Apply the Four Moments of Antibiotic Decision-Making
Understand how the CUSP approach can improve safety culture
Understand how to use the “Team Antibiotic Review Form” to review antibiotic use with frontline staff
Understand how to access data and upload data on the AHRQ Safety Program websiteSlide18
Antibiotic Stewardship Program (ASP) Development
Antibiotic Stewardship Team
May 2017
Understand the key personnel for developing an ASP
Understand how to work with a senior executive to further program goals
Discuss the pros and cons of common ASP interventions
Discuss the evaluation metrics for ASPs
Understand the steps involved in establishing an ASPSlide19
Improving Antibiotic Use is a Patient Safety Issue (CUSP 1)
AS Team, Unit Champions,
Frontline staff
M
ay
2017
Discuss
the potential harm associated with antibiotic use
Understand that patient harm is largely preventable
Understand that change efforts often require a focus on systems, not
individuals
Recognize the principals involved in safe design
Understand the importance of diverse input to prevent harmSlide20
Behavior Change Theory for
Antibiotic Stewardship Leaders
AS Team
June 2017
Understand what motivates health care providers to prescribe antibiotics
Understand basic theories regarding implementation science and organizational change to implement AS interventions and to change prescribing habits
Understand successful AS behavior interventions in the acute care settingSlide21
Identifying Targets for Improving Antibiotic Use (CUSP 2)
Month:
AS Team, Unit Champions, Frontline staff
June 2017
Understand how to identify patient safety risks in their clinical areas
Understand how to be proactive in asking staff how the next patient will be harmed
Understand how to leverage frontline wisdom to guide safety improvement effortsSlide22
Improving Antibiotic Use by Learning from Defects (CUSP 3)
AS Team, Unit Champions, Frontline staffJuly 2017
Understand how to identify the relevant system factors related to defects in a system
Develop interventions to reduce future risk
Ensure that interventions are effectively addressing defects related to antibiotic prescribingSlide23
Improving Teamwork and Communication Around Antibiotic Prescribing (CUSP 4)
AS Team, Unit Champions, Frontline staff
July 2017
Understand the importance of seeking input from all team members when making antibiotic prescribing decisions
Understand how to use available AHRQ Safety Tools to improve communication related to The Four Moments of Antibiotic Decision-Making
Understand how to effectively communicate potential harm antibiotics can cause with patients and other health care providersSlide24
The Team Approach to Stewardship of Asymptomatic Bacteriuria and Urinary Tract Infections
AS Team, Unit Champions, Frontline staff
August 2017
Understand
how to distinguish asymptomatic bacteriuria, cystitis, and pyelonephritis
Develop empiric treatment recommendations for UTIs that are institution specific and minimize adverse events
Discuss opportunities for de-escalation of antibiotic therapy for UTIs after additional clinical data are available
Discuss reasonable durations of antibiotic therapy for UTIs
Discuss challenges and ambiguities in developing and executing a standardized approach to the management of asymptomatic bacteriuria and urinary tract infectionsSlide25
Additional Syndrome-Specific Modules
Team Approach to Stewardship of—
Community-Acquired Lower Respiratory Tract Conditions
September 2017
Healthcare-Associated Pneumonia and Ventilator-Associated Pneumonia
October 2017
Skin and Soft Tissue Infections
November 2017
Intra-Abdominal Infections
December 2017
Clostridium difficile
Infections
January 2018
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Coaching Call About Team-Based Stewardship Implementation
AS Team, Unit Champions, Frontline staffFebruary 2018
Discuss barriers to and potential mitigation strategies for implementation of team-based stewardship interventions Slide27
Sustaining Antibiotic Stewardship Efforts
ASP team, unit champions, frontline staff
March 2018
Understand
the need for stewardship interventions to be sustained to have a continued effect
Discuss approaches for identifying new stewardship targets
Discuss personnel and resources necessary for a stewardship program to successfully be
sustainedSlide28
Additional Educational Material
Pamphlets
Posters
Antibiotic time-out tool
Team Antibiotic Review Form
Fast fact
sheets
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Benefit Summary
Education for ASPs and frontline providers in approaches to improve antibiotics useAssistance with addressing the behavior and cultural drivers of antibiotic prescribingApproaches to improve teamwork related to antibiotic prescribingAccess to experts and peers to enhance learning and collaboration
Access to materials and approaches to ensure compliance with The Joint Commission Antimicrobial Stewardship Standard
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Questions
Type in your questions using “Chat”
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Next Steps
Onboarding 1 WebEx call
Onboarding 2 WebEx call
Questions?
antibioticsafety@jhmi.edu
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