Antimicrobial Stewardship

Transcription

1 Antimicrobial Stewardship Safe Table Webcast / EQUIP Workbook for Alaska Meg Kilcup, PharmD, Director Safe Medication Practices WSHA March 14, 2017

2

3 Objectives Overview of the EQUIP Jump Start Stewardship Workbook Empower you to take what you hear today back to your teams and implement (or advance) your AMS Program!

4 Roadmap for Action Here s a quick look at the main steps we will be covering today. Time to get on the road!

5 Current State Assessment Present activities, resources and structures relative to a desired state conducive to AMS Conduct analysis pre-planning of program and periodically thereafter For best results, work with multiple knowledgeable people in your hospital to determine the most realistic answers to the questions.

6 Current State Assessment Use this questionnaire adapted from CDC s Core Elements. This will be for your team s own assessment.

7 Snapshot of Assessment The assessment is on pages 8 14 of the EQUIP Workbook.

8 Identifying Key Stakeholders Stewardship is a TEAM SPORT! Know who is: On your team. Rooting for your team! May stand in the way of your success. Key stakeholders will have a fundamental impact on your AMS Program s performance and must be POSITIVELY engaged for the program to be successful.

9 Identifying Key Stakeholders Questions to Consider: 1. Does the stakeholder have a fundamental impact on your program s successful performance? 2. Can you clearly identify what you want from the stakeholder support? 3. Can the program meet it s goals without the stakeholder s support?

10 Identifying Key Stakeholders See the Stakeholder Identification Worksheet Pages 18 and 19 in the workbook!

11 Building Your Team and Resources The ideal AMS Team according to IDSA/SHEA: Infectious Disease physician Clinical Pharmacist with ID training Clinical microbiologist Information system specialist Infection preventionist Hospital epidemiologist However, for many small, rural and critical access hospitals, this arrangement may not be feasible. Therefore, at a minimum, to ensure your AMS should is successful and efficient, plan thoroughly and specifically for your facility s individual personnel, resources and other strengths!

12 Team ID Worksheet This is a snapshot. Refer to pages for the following: Team identification worksheet Committee oversight worksheet and chart Resource needs assessment

13 What Next? Interventions and Targets for Implementing Four main drivers of stewardship Leadership and culture change Timely and appropriate initiation of antibiotics Appropriate admin and de-escalation of therapy Data monitoring, transparency and stewardship but note. The program does not need to be implemented in it s final version. See p. 28

14 Interventions Assessment of AMS Interventions See page 30s and 31 Recommended by IDSA and SHEA Consider WHICH interventions might be right for your hospital or ways you might modify or adapt one or more

15 Interventions Feasibility of AMS Interventions Worksheet See pages 32 and 33 Tailor to areas (populations, units, drugs) with most opportunity for improvement! Consider several and then assess which might be most supported by clinical staff. Score dach from 0 to 5 relative to conditions specific to YOUR hospital!

16 Measuring Effectiveness Know in advance what your baseline is! We know that about 30 50% of antibiotic use (AU) is either unnecessary or inappropriate and that AU is closely lined to bacterial resistance and CDI. Make sure the following: The hospital population whose metrics are being monitored is subject to the AMS intervention. That your intervention was adequately implemented. Regular (monthly or quarterly) reports go to AMS team and at least one annual report to leadership or quality. To choose appropriate timeframes for comparison of before and after implementation.

17 Data Sources and Metrics Worksheet / p. 36

18 Barriers and Mitigations Identifying and Mitigating Barriers to Success Culture and resources are critically important and can also be the largest barriers. Challenges are many and can include lack of C suite support, insurmountable up front costs, physician push back, lack of ID trained pharmacist or physician, etc. Example of mitigation strategy: Make sure the C suite is aware of the value of your AMS program. Justify the investment and communicate a clear vision, including expected benefits and reduced costs associated with overuse or misuse of antibiotics, reduced LOS and reduced costs associated with ADEs and toxicity.

19 SWOT Analysis Strengths, Weaknesses, Opportunities, Threats p. 40

20 Barriers and Mitigation Plan Using the SWOT Analysis, list three or four of the most likely and/or serious barriers/threats identified. Then list potential ways you can proactively mitigate the barriers. p. 41

21 Make your PLAN! Plan Interventions and Create Timelines To jump start, set realistic goals and commit to a timeline. Consider one of the interventions selected as a start. Don t get too far into the weeds. Keep the # of steps per intervention to 10 or less. Use the worksheet to assign human resources to each step and record goals and tangible deliverables. Once you have completed the plan, use a NEW blank one for planning your second intervention! (See Make your Timeline and Plan Visible on p. 44)

22 Business Case Start small, and show them the money! Primary goal of AMS are improvements in patient outcomes, but your AMS program can also result in substantial cost savings (or cost avoidance!). Use the worksheets available to develop a business case AMS interventions that avoid costs: Decreased LOS Decreased incidence of CDI Decreased antibiotic resistance Decreased incidence toxicity AMS interventions that save costs: Conversion of IV to PO (p.48) Restriction of High Cost Antibiotics Reduction in Overall Use

23 See p. 50 for ideas on how formulary restriction and prior authorization can result in cost savings!

24 Measure Your Improvement! For specific classes of antibiotics, calculate the days of therapy (DOT).

25 Business Case Calculations Helps layout the HR anticipated hours per week, salary, etc. p. 54

26 Put It All Together! Develop a Charter and Strategic Plan The charter will be used to facilitate communication about your new program to hospital leaders, staff and prescribers. The charter states your commitment and provides readers with background information and purpose of the AMS program, a summary of the business case and anticipated financial impact. Once you have your leader s support, get started! Know you will need to adjust as needed to achieve your goals, milestones and aim.

27 See pages 58 and 59 for an excellent template for your Charter and Strategic Plan.

28 Congratulations! You have jump-started a feasible, small-scale Antimicrobial Stewardship Program!

29 Gather Your Team Next step: Set aside time to meet with your stakeholders and team so you can put this workbook to use. It can be used to launch or improve a program!

30 Thanks for Joining! WSHA Medication Safety Homepage: Contact: