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: megk@wsha.org

WSHA Medication Safety Homepage: http://www.wsha.org/quality-safety/projects/medication/