antimicrobial stewardship abs/dot tracking

Montana ABS/DOT Tracking

& ReportingFebruary 7, 2019

JAMIE SCHULTZ

A N T I M I C R O B I A L S T E WA R D S H I P C O L L A B O R AT I V E : M T F L E X P R O G R A M

CHUN WONGLEON BABAKHANIAN

A S O LVA I N CM E D I C I AU R S O F T WA R E

Introduction

2/7/2019 MT ABS/DOT TRACKING & REPORTING 2

SPEAKERS

Jamie ShultzAntimicrobial Stewardship CollaborativeMT Flex Program

Chun Wong, Leon BabakhanianAsolva IncMedici® Antibiotic Use and Resistance Reporting Software

TOPIC

Addressing barriers to AU Reporting for NHSN & meeting DPHHS requirements▪ Using the MT ABS/DOT Tracking Tool

▪ Medici file upload

Background

2/7/2019

Why report/track antimicrobial use?▪ Efforts to reduce antimicrobial resistance

▪ Benchmarking against peer facilities

What are the data requirements for NHSN AU reporting?▪ Administered Medication Data

▪ Admission Dates

▪ Nursing Unit Transfer History

What are reporting expectations for MT Hospitals?▪ NHSN: Facility Annual Survey--aim of 100% of facilities

submitting to AU Module

▪ DPHHS: build a statewide database for improving antibiotic prescribing/utilization

MT ABS/DOT TRACKING & REPORTING 3

Common Barriers (Real & Perceived)2/7/2019 MT ABS/DOT TRACKING & REPORTING 4

Time Consuming Lack of IT Resources

Data locked in EHR Cost

Which Data Extraction Method for you?2/7/2019 MT ABS/DOT TRACKING & REPORTING 5

Resource CapacityData Extraction Method

A: Manual B: EHR File C: EHR Direct

EHR Support None/Minimal None/Minimal Full

Pharmacist Support None/Minimal None/Minimal Yes

IP Support Yes Yes Yes

NHSN AU Reporting Not ready Ready Ready

Facility Size CAH Any Any

MontanaABS/DOT

Tracking Tool

Method A: Manual


Fac Pt Unit Med Route Date~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~

MontanaABS/DOT

Tracking Tool

Method B: EHR File


Your EHRMEDITECH®, Cerner®,Evident/CPSI®, Epic®,

your homegrown,and others ?

MontanaABS/DOT

Tracking Tool

Method B: EHR File


MEDICI®Cloud Abx Use &Resistance Engine


Fac Pt Unit Xin Xout Xkey~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~

Fac Enc Adm DC~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~Your EHR

MEDITECH®, Cerner®,Evident/CPSI®, Epic®,

your homegrown,and others

Your EHR Reports

CDA

AUValidator

NHSNSubmission

Confer Rights

MontanaABS/DOT

Tracking Tool

Method C: EHR Direct


Your EHR

Confer Rights

Solution Time: Method A

ABS/DOT Tracking Tool Overview


New! MAR report for upload generated from spreadsheet. Additional report formats for

your IT department’s assistance

Updated instructions for latest version of the tool

Instruction Tab


Days Present by Location Tab

Updated! Each separate patient location has a dedicated column


Facility ABX Data Tab

• Tool updates:• All columns with green headings are required and align with NHSN

AU Module upload (exception- Every dose is on a separate line for MAR upload- DOT is calculated on this tool for use in graphs and tables)

• MAR report is automatically populated when you fill in this data-more instructions available on that tab

• Each location is separately tracked- aligns with NHSN• Drop down menus are still utilized wherever possible and can be

modified for your facility


Facility ABX Data Tab: Continued

Additional fields for Performance Improvement are still available!


Drop Down Selections Tab

Drop Down Menus are all customizable for your use. If you add,

edit or remove an item from the column (within the box) the changes will appear in the Facility ABX Data

drop down menus


Graphs Available: ABX RATE & DOT

• Notes:• Refresh your data to update your graphs- directions on each

tab• Use filters on pivot table charts to look at specific information• Use copy/paste, snipping tool or print to pdf (requires

formatting) to add graphs to your reports

ABX Rate Graph:Antibiotic Prescribing Rate by Location: Total Number of Antibiotics Prescribed in Each Location by Total Number of Patient Days andNumber of Each Antibiotic Prescribed per Month

DOT Rate Graph:Days of Therapy Rate by Location= Total Days of Antibiotics Administered in Each Location by Total Number of Patient Days


Graphs Available: ABX prescribed per month by Prescriber

Antibiotics prescribed by each provider/month


Graphs Available: ABX Class Utilization per Month

Antibiotics Classes prescribed each month by location (can filter by prescriber)


Graphs Available: ABX Class by Primary Indication

ABX Class by Primary Indication:Antibiotic Class prescribed for Each Primary Indication: Not a required field, but a great start for PI!


Preparing for file uploading to Medici- MAR Tab

ACTION REQUIRED in order to use for upload!! DOT is not a calculated field on the actual MAR report, there is a line for every day the patient receives an antibiotic in each location.

Using the DOT Data, you will need to add days as additional rows in your report for any DOT greater than one.

This report is pulled from your ABX Facility Data spreadsheet.. It has the required fields in the correct order for upload.

Example: For patient 16519-0004 (DOT=3):1. Insert 2 blank rows after

the original row2. Copy the row3. Paste it into the 2 blank rows

(text only)4. Change "First Date Taken

in Location" to 8/30/2018 and 8/31/2018 respectively

✓ You now have a single day of therapy on each row.2/7/2019 MT ABS/DOT TRACKING & REPORTING 20

Preparing for file uploading to Medici- Transfers- All Patients All Departments & INPATIENT ADMISSIONS

For information only: These two tabs show the fields included in the 2 additional reports to download from your EHR. Share with your IT to start the process of getting the correct fields in your CSV file.


Solution Time: Method A


•Next Steps:•NHSN enrollment and submit Annual Facility Patient Safety Survey- familiarize yourself with the AU Module•Updated tool generates the most complicated of the reports for upload (MAR)

•Familiarize IT with the other two reports and see if they can pull for you

•Reach out to Asolva for Method B consideration

Method B: EHR File

If a picture is worth a thousand words, then a demo is worth a million pictures

Demo


Jump Starting the data extraction process

Do you have EHR report builder or direct database access?


---- Copyright (c) Asolva, Inc. All rights reserved.-- To be used only in support of Asolva Medici(R) product.--DECLARE @SourceID VARCHAR(3);

DECLARE @FromDate DATETIME,@ThruDate DATETIME;

SET @FromDate = '2018-02-01';SET @ThruDate = '2018-05-31 23:59:59';

SELECTRM.Facility_MisFacID AS [Facility],RX.VisitID AS [PatientID],SCU.SpecialCareUnitLocation_MisLocID AS [Ward],UPPER(GEN.Name) AS [Medication],RX.RouteOfAdministration AS [Route],PRA.AdministrationDateTime AS [TakenDate],COALESCE(MPN.NameStoredLast + ', ' + MPN.NameStoredFirst, RX.ProviderID) AS[Prescriber],SPEC.Name AS [Specialty]

FROMlivendb.dbo.PhaRxAdministrations PRA

INNER JOIN livendb.dbo.PhaRx RXON RX.SourceID = PRA.SourceIDAND RX.PrescriptionID = PRA.PrescriptionID

Report Builder (e.g. Cerner® DA2)

SQL Query code (e.g. MEDITECH® DR Database)

Creating the 3 monthly data extraction files


MAR Admission

Nursing UnitTransfer

Creating your EHR files for upload into MEDICI®



Fac Pt Unit Xin Xout Xkey~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~~

Fac Enc Adm DC~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~~~~ ~~~ ~~~ ~~~

Method B: EHR File

Validating your AU Data using MEDICI®Stratify by

• Medication

• Taken Date

• Nursing Unit

• Specialty

• Prescriber

Measure by

• Days of Therapy

• Admissions

• Days Present

• DOT per 1000 Patient Days


Method B: EHR File

NHSN Reporting• Monthly reporting

• MEDICI® generates datafile (CDA) for NHSN

• Import datafile into NHSN web portal


CDA

Method B: EHR File

Recent Experiences

Benefis Teton Medical Center, Choteau, MT◦ Penny Smoot

◦ EHR: Healthland

◦ Using both MT ABS/DOT reporting tool and Medici® NHSN AU Module

Teton Valley Medical Center, Driggs, ID◦ Nikki Ripplinger

◦ EHR: Athena

Frances Mahon Deaconess Hospital, Glasgow, MT◦ Angela Kemp

◦ EHR: Meditech

Marcus Daly Memorial Hospital, Hamilton, MT◦ Kellie Jones

◦ EHR: Cerner Community Works


Recent ExperiencesWhich EHR? Athena, Meditech Magic 5.67, Cerner Community Works, Healthland

IT Capabilities/Resources:◦ "We have two IT people; they were unwilling or unable to help"◦ "Full IT staff with report writer"◦ "Full IT Dept, we had to utilize them to build the initial report in the Cerner DA2 reporting tool"◦ "I have IT at the main campus, but they don’t use Healthland and can’t help a lot with any issues with it. I’m

pretty much on my own here to work through issues with Healthland itself."

Who is responsible for this?◦ "My Pharmacist and I set it up, I submit to NHSN"◦ "Pharmacist set up with Medici – Our Quality person that submits other data for the hospital to NHSN now also

submits our antibiotic data"◦ "Director of QI and Director of Pharmacy (also got additional pharmacist setup with NHSN reporting capability)"◦ "I am the only one involved with this process"

How long did it take you to get set up?◦ "It took about 3-4 months from start to submission of data”◦ “Took several phone calls and way too many emails over a time period of 3 weeks or so"◦ "I have been set up with NHSN for a couple years, so that wasn’t the issue. I started working with Medici last

Aprilish. I did just the free sample thing for several months trying to see if it was going to work for us."


Recent ExperiencesChallenges/Barriers:

"Athena was our major barrier"

"The hardest part was getting the reports built so it pulled all the data that is needed"

"A simple PDF guide explaining how mapping to NHSN needs to match for name/location and ordering of data columns would have simplified the process and save multiple emails. Also, including a simple how to on importing the reports would have been useful"

"Healthland doesn’t have a report that will pull all of the administration dates and times. That is still a manual process for me. I can pull the meds that are given and then manually look up the administration dates/times. I still struggle some in keeping organized with a streamlined process. I’m hoping the spreadsheet that you are doing will help with some of the organization problems I have. I struggle with getting the reports cleaned up enough to get them submitted and accepted all the time."

How did you overcome them?"My pharmacist worked and worked to learn how to pull the data we needed, Asolva helped as a resource to him"

"Emails/phone"

"I haven’t overcome the manual parts of this process. I feel that Healthland needs to step up and be able to print out administration dates and times, but so far they are not able to fix this or make it work correctly for me. I still have issues manipulating my reports to csv files at times and getting them submitted... It would help if I just did it every month instead of every few months, because I really have to think how to get the data into the form that I need each time."


Next Steps

▪ Workgroups based on EHRs- with IT and IP/Pharmacy

▪ Sharing reports

▪ Ongoing assistance with ABS Tracking Tool and generating files

▪ Performance Improvement based on data!!!


Contact Us!

For assistance with ABS Tracking Spreadsheet or to reach out to the ABS Collaborative for information:Jamie Schultz, MSE

Rural Hospital Improvement Coordinator, MHA

Office: (406) 457-8002| Fax: (406)443.3894

2625 Winne Avenue, Helena, MT 59601

[email protected]

For assistance with Medici® for EHR data extraction and NHSN SubmissionLeon BabakhanianAsolva Inc877-543-1088 x816416 S. Marengo Ave, Suite 202Pasadena, CA [email protected]


mailto:[email protected]

mailto:[email protected]

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