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IHI ExpeditionAntibiotic Stewardship Session 2:
Promoting a Culture for Optimal Antibiotic Use
April 3, 2014
These presenters have
nothing to disclose
Diane Jacobsen, MPHLoria Pollack, MD
Today’s Host2
Sarah Konstantino, Project Assistant, Institute for
Healthcare Improvement (IHI), assists in programming
activities for expeditions, as well as maintaining
Passport memberships, mentor hospital relations and
collaboratives. Sarah is currently in the Co-Operative
Education Program at Northeastern University in
Boston, MA, where she majors in Business
Administration with a concentration in Management
and Health Science. She enjoys cooking, traveling, and
fitness.
Audio Broadcast3
You will see a box
in the top left hand
corner labeled
“Audio broadcast.”
If you are able to
listen to the
program using the
speakers on your
computer, you
have connected
successfully.
Phone Connection (Preferred)4
To join by phone:
1) Click the
button on the right
hand side of the
screen.
2) A pop-up box will
appear with call in
information.
3) Please dial the phone
number, the event
number and your
attendee ID to connect
correctly .
Audio Broadcast vs. Phone Connection
If you using the audio broadcast (through your
computer) you will not be able to speak during the
WebEx to ask question. All questions will need to come
through the chat.
If you are using the phone connection (through your
telephone) you will be able to raise your hand, be
unmuted, and ask questions during the session.
Phone connection is preferred if you have access to a
phone.
5
WebEx Quick Reference
• Welcome to today’s
session!
• Please use chat to “All
Participants” for questions
• For technology issues only,
please chat to “Host”
• WebEx Technical Support:
866-569-3239
• Dial-in Info: Communicate /
Join Teleconference (in
menu)
6
Raise your hand
Select Chat recipient
Enter Text
7
When Chatting…
Please send your message to
All Participants
Expedition Director8
Diane Jacobsen, MPH, CPHQ, Director, Institute for Healthcare Improvement (IHI) is currently directing the CDC/IHI Antibiotic Stewardship Initiative, NSLIJ/IHI Reducing Sepsis Mortality Collaborative. Ms. Jacobsen served as IHI content lead and improvement advisor for the California Healthcare-Associated Infection Prevention Initiative (CHAIPI) and directed Expeditions on Antibiotic Stewardship, Preventing CA-UTIs, Reducing C.difficle Infections, Sepsis, Stroke Care and Patient Flow. She served as faculty for IHI’s 100,000 Lives and 5 Million Lives Campaign and directed improvement collaboratives on Sepsis Mortality, Patient Flow, Surgical Complications, Reducing Hospital Mortality Rates (HSMR) and co-directed IHI’s Spread Initiative. She is an epidemiologist with experience in quality improvement, risk management, and infection control in specialty, academic, and community hospitals. A graduate of the University of Wisconsin, she earned her master’s degree in Public Health- Epidemiology.
Today’s Agenda9
Introductions
Debrief: Action Period
Assignment
Promoting a Culture for
Optimal Antibiotic Use
Action Period Assignment
Expedition Objectives
At the end of this Expedition, participants will be able to:
Describe the impact of overuse and misuse of antibiotics
on costs of care, antimicrobial resistance and patient
complications, including Clostridium difficile.
Establish a multidisciplinary focus to embed antibiotic
stewardship into the process of care.
Identify and begin improving at least one key process to
optimize antibiotic selection, dose, and duration of
antibiotics in the patient care setting.
10
Schedule of Calls
Session 1 – “Making the Case” for Antibiotic StewardshipDate: Thursday, March 20
th2:30 PM – 4:00 PM ET
Session 2 – Promoting a Culture for Optimal Antibiotic UseDate: Thursday, April 3, 3:00 – 4:00 PM ET
Session 3 – Our Learning Journey: IHI & CDC PartnershipDate: Thursday, April 17, 3:00 – 4:00 PM ET
Session 4 – Embedding Stewardship Processes into Care DeliveryDate: Thursday, May 1, 3:00 – 4:00 PM ET
Session 5 – Focus on: 72 Hour Antibiotic “Time-out”Date: Thursday, May 15, 3:00 – 4:00 PM ET
Session 6 – What Are We Testing & Learning?Date: Thursday, May 29, 3:00 – 4:00 PM ET
11
Ground Rules12
We learn from one another – “All teach, all learn”
Why reinvent the wheel? – Steal shamelessly
This is a transparent learning environment – Share
Openly
All ideas/feedback are welcome and encouraged!
Action Period Assignment
Review the seven core elements and identify areas of
strength and areas of opportunity.
Identify one specific intervention to focus on during the
expedition
Identify a group of people/providers that you’re not
currently engaging with that you will create a partnership
with to support stewardship
13
Core Elements for Antibiotic Stewardship Programs
Leadership commitment from administration
Single leader responsible for outcomes
Single pharmacy leader
Specific improvement interventions
Antibiotic use tracking
Regular reporting on antibiotic use and
resistance
Educating providers on use and resistance
Action Period Assignment
One specific intervention you plan to focus on during the
expedition related to one of the Core Elements
- Use the Chat Box to share
- If you’re connected by phone, raise your hand to
discuss
15
Action Period Assignment
Identify the group of people/providers that you’re not currently engaging with that you plan to create a partnership with to support stewardship
- Use the Chat Box to share: who? what unit? what discipline? (hospitalists, pharmacists, microbiology, infection prevention, leadership)
- If you’re connected by phone, raise your hand to discuss
16
Faculty17
Lori A. ‘Loria’ Pollack, MD is a U.S. Public Health Service Medical Officer in the Division of Healthcare Quality Promotion (DHQP) at Centers for Disease Control and Prevention (CDC) in Atlanta, GA. Dr. Pollack received degrees in medicine and public health (MD, MPH) from UMDNJ-Robert Wood Johnson Medical School in 1999 and completed an internal medicine residency at Columbia University’s primary care program in Cooperstown, NY. She joined CDC in 2002 as an Epidemic Intelligence Service Officer. Dr. Pollack was an epidemiologist in the Division of Cancer Prevention and Control where she led national efforts related to cancer survivorship. After 8 years at the federal level, she transitioned to work with the medical director of the local public health department in Atlanta, Georgia where she completed a second residency in Preventive Medicine. In July 2012, Dr. Pollack returned to CDC to focus on preventing healthcare-associated illness and addressing antibiotic resistance through antimicrobial stewardship. Dr. Pollack is board-certified in Internal Medicine and Preventive Medicine. She is the author or coauthor on more than 35 papers in epidemiology and health service research. A driving theme in Dr. Pollack’s diverse public health career is the translation and dissemination of research into practical guidance and tools improve health and health care.
Loria Pollack, MD, MPHDivision of Healthcare Quality Promotion
Centers for Disease Control and Prevention
April 3, 2014
Promoting a Culture
of Optimal Antibiotic Use
IHI Expedition: Antibiotic Stewardship
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
Learning Points
Engaging physicians
Making teams work
Moving ideas into practice
Antibiotic Stewardship
Strategic efforts to optimize antibiotic
prescribing
Multidisciplinary
Organizational approach
Facility-specific
Core Elements of Hospital
Antibiotic Stewardship Programs
Leadership Commitment
Accountability
Drug Expertise
Action
Tracking
Reporting
Education
http://wwwdev.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf
Core Elements of Hospital
Antibiotic Stewardship Programs
Leadership Commitment
Accountability
Drug Expertise
Action
Tracking
Reporting
Education
http://wwwdev.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf
Antibiotic Stewardship
Leadership The art of getting someone to do something
because he or she wants to do it
Culture A set of shared attitudes, values, goals, and
practices that characterize an organization
ENGAGING PHYSICIANS
Engaging Clinicians
2007 IHI White Paper
Framework for physician
involvement in quality
improvement
http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx
Discover Common Purpose
Improve patient outcomes through reduced
C. difficile infections
Adverse effects related to antibiotics
Antibiotic resistance leads to higher mortality
Reframe Values and Beliefs
Promote both system and individual
responsibility for quality improvement
http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx
System Individuals
• Prescribing is an act
within a system
• Successful
approaches reach
beyond the prescriber
• The responsibility to
optimize antibiotic use
relies on individuals
Segment the Engagement Plan
Use the 20/80 rule
Identify and activate champions
Educate and inform structural leaders
http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx
Ways to Improve Engagement
Standardize what is ‘standardizable’
Generate light, not heat, with data
Make the right thing easy to try, and
Easy to do
http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx
Adopt an Engaging Style
Involve physicians from the beginning
Make physician involvement visible
Communicate candidly, often
http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx
MAKING TEAMS WORK
Antimicrobial Stewardship
Multidisciplinary Team
• Risk assessment and prevention planning skills
• Collect, analyze and report antibiotic-related data
Infection Preventionists
• Input into specimen collection and proper use of relevant tests
• Review information flow of results to clinicians
• Create and interpret a facility antibiotic resistance report Laboratory
• Review medications as part of their routine duties
• Could contribute through prompting discussions of antibiotic treatment, indication, and duration
Nursing
• Create ways integrate guidelines and policies with decision support at point of care
• Track antibiotic use through medication administration records
Information Technology (IT)
Making Teams Works
Clear, common vision
Stewardship and ‘improve use’ are ambiguous
Need to identify specific, measurable goals
Clarify member skills and responsibilities
What value does each member bring?
What role can their discipline have in improving
practice?
Growing a Team
Willingness to explore ideas
Use disagreement constructively
Share success, learn from failure
Accomplishments reinforce efforts
Problem-solving builds purpose
MOVING IDEAS INTO PRACTICE
Diffusion of Innovations Theory
Everett Rogers – rural sociologist (1962)
Factors that impact spread of new ideas and
changes in practice
Four elements
Idea (Innovation)
Process of adopting the idea
Time
Social system
Fit with existing
values and practice
Simplicity
Ease of use
Ability to try and
experiment
Visible results
Diffusion of Innovations
Rogers E. (1962, 1983) Diffusion of Innovations. NY: Free Press
Knowledge
Persuasion
Decision
Implementation
Confirmation
Five stages of adoption
of a new idea or practiceFactors influencing
adoption
Diffusion of Innovations
Categories of
Adopters
Innovators
Early adopters
Early majority
Late majority
Laggards
Rogers E. (1962, 1983) Diffusion of Innovations. NY: Free Press. Graphic: Wikipedia
Diffusion of InnovationsApplied to Antibiotic Stewardship
Knowledge through education
Persuasion through antimicrobial policies
Decision and implementation of ideas by choosing
activities based on factors that influence adoption
Confirmation through tracking and reporting
Support dissemination of successful practices
Moving from early adopters to early then late majority
Highlighted words are core elements of stewardship program
Core Elements of Hospital
Antibiotic Stewardship Programs
Leadership Commitment
Accountability
Drug Expertise
Action
Tracking
Reporting
Education
http://wwwdev.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf
Summary
Successful antibiotic stewardship programs
depend on leadership and culture
Key factors that promote a culture of optimal
antibiotic use are:
Engaging physicians
Energizing a team
Understanding factors that influence the adoption
of new practices
For more information please contact Centers for Disease Control and
Prevention1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Thank you
Loria Pollack, MD, MPH
CDC/Division of Healthcare Quality and Promotion
Email: [email protected]
Phone: (404) 639-1154
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
Questions?43
Raise your hand
Use the Chat
Action Period Assignment
Based on today’s discussion and feedback from other participants:
Refine/Re-focus one specific intervention to focus on during the expedition
Test one idea for Promoting a Culture for Optimal Antibiotic Use with the group of people/providers you identified to create a partnership with to support stewardship
Come prepared to share your plans at the next session
44
Expedition Communications
Listserv for session communications:
To add colleagues, email us at [email protected]
Pose questions, share resources, discuss barriers or
successes
45
Next Session
Thursday, April 17th, 3:00 PM – 4:00 PM ET
Session 3 – Our Learning Journey: IHI & CDC
Partnership
Arjun Srinivasan MD
Centers for Disease Control and Prevention
Scott A. Flanders, MD, MHM
Jeff Rohde, MD
University of Michigan
46