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TRANSCRIPT
Antimicrobial StewardshipSafe Table Webcast / EQUIP Workbook for Alaska
Meg Kilcup, PharmD, Director Safe Medication Practices WSHAMarch 14, 2017
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!
Roadmap for Action
Here’s a quick look at the main steps we will be covering today.
Time to get on the road!
• 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.
Current State Assessment
Current State Assessment
Use this questionnaire adapted from CDC’s Core Elements.
This will be for your team’s own assessment.
The assessment is
on pages 8 – 14of the EQUIP
Workbook.
Snapshot of Assessment
Stewardship is a TEAM SPORT!• Know who is:
• On your team.• Rooting for your team!• May stand in the way of your success.
Identifying Key Stakeholders
Key stakeholders will have a fundamental impact on your AMS
Program’s performance and must be POSITIVELY engaged for the program
to be successful.
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?
Identifying Key Stakeholders
See the Stakeholder Identification Worksheet
Identifying Key Stakeholders
Pages 18 and 19
in the workbook!
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
Building Your Team and Resources
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!
Team ID Worksheet
This is a snapshot.
Refer to pages 22 – 25 for the following:
• Team identification worksheet
• Committee oversight worksheet and chart
• Resource needs assessment
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”.
What Next?
See p. 28
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
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!
Interventions
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.
Data Sources and Metrics Worksheet / p. 36
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.
Barriers and Mitigations
Strengths, Weaknesses, Opportunities, Threats
SWOT Analysis
p. 40
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.
Barriers and Mitigation Plan
p. 41
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)
Make your PLAN!
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
Business Case
See p. 50 for ideas on how formulary restriction and prior authorization can result in cost savings!
Measure Your Improvement!
For specific classes of antibiotics, calculate the days of therapy (DOT).
Business Case Calculations
p. 54
Helps layout the HR anticipated hours per
week, salary, etc.
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.
See pages 58 and 59 for an excellent template for your Charter and Strategic Plan.
Congratulations! You have jump-started a feasible,
small-scale Antimicrobial Stewardship Program!
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!
Thanks for Joining!
Contact: [email protected]
WSHA Medication Safety Homepage: http://www.wsha.org/quality-safety/projects/medication/