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IHI Expedition Antibiotic Stewardship Session 2: Promoting a Culture for Optimal Antibiotic Use April 3, 2014 These presenters have nothing to disclose Diane Jacobsen, MPH Loria Pollack, MD

IHI Expedition · 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

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Page 1: IHI Expedition · 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

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

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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.

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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.

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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 .

Page 5: IHI Expedition · 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

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.

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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

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7

When Chatting…

Please send your message to

All Participants

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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.

Page 9: IHI Expedition · 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

Today’s Agenda9

Introductions

Debrief: Action Period

Assignment

Promoting a Culture for

Optimal Antibiotic Use

Action Period Assignment

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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.

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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

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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!

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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

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Page 14: IHI Expedition · 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

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

Page 15: IHI Expedition · 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

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

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Page 16: IHI Expedition · 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

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

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Page 17: IHI Expedition · 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

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.

Page 18: IHI Expedition · 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

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

Page 19: IHI Expedition · 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

Learning Points

Engaging physicians

Making teams work

Moving ideas into practice

Page 20: IHI Expedition · 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

Antibiotic Stewardship

Strategic efforts to optimize antibiotic

prescribing

Multidisciplinary

Organizational approach

Facility-specific

Page 21: IHI Expedition · 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

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

Page 22: IHI Expedition · 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

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

Page 23: IHI Expedition · 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

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

Page 24: IHI Expedition · 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

ENGAGING PHYSICIANS

Page 25: IHI Expedition · 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

Engaging Clinicians

2007 IHI White Paper

Framework for physician

involvement in quality

improvement

http://www.ihi.org/knowledge/Pages/IHIWhitePapers/EngagingPhysiciansWhitePaper.aspx

Page 26: IHI Expedition · 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

Discover Common Purpose

Improve patient outcomes through reduced

C. difficile infections

Adverse effects related to antibiotics

Antibiotic resistance leads to higher mortality

Page 27: IHI Expedition · 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

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

Page 28: IHI Expedition · 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

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

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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

Page 30: IHI Expedition · 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

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

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MAKING TEAMS WORK

Page 32: IHI Expedition · 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

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)

Page 33: IHI Expedition · 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

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?

Page 34: IHI Expedition · 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

Growing a Team

Willingness to explore ideas

Use disagreement constructively

Share success, learn from failure

Accomplishments reinforce efforts

Problem-solving builds purpose

Page 35: IHI Expedition · 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

MOVING IDEAS INTO PRACTICE

Page 36: IHI Expedition · 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

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

Page 37: IHI Expedition · 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

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

Page 38: IHI Expedition · 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

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

Page 39: IHI Expedition · 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

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

Page 40: IHI Expedition · 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

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

Page 41: IHI Expedition · 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

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

Page 42: IHI Expedition · 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

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

Page 43: IHI Expedition · 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?43

Raise your hand

Use the Chat

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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

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Page 45: IHI Expedition · 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

Expedition Communications

Listserv for session communications:

[email protected]

To add colleagues, email us at [email protected]

Pose questions, share resources, discuss barriers or

successes

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Page 46: IHI Expedition · 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

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

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