Geriatric Mental Health Partnership

Transcription

1 Geriatric Mental Health Partnership September 8, 2017

2 First, let s test your knowledge about antibiotics 2

3 Get Smart Antibiotics Quiz Antibiotics fight infections caused by.. 1. Antibiotics 2. Bacteria 3. Viruses 4. Viruses and Bacteria 3

4 Get Smart Antibiotics Quiz Bacteria are germs that cause colds and flu. 1. True 2. False 4

5 Get Smart Antibiotics Quiz Which of these illnesses should be treated with antibiotics? 1. Runny Nose 2. The Flu 3. Cold 4. Strep Throat 5

6 Get Smart Antibiotics Quiz Bacteria that cause infections can become resistant to antibiotics. 1. True 2. False 6

7 Get Smart Antibiotics Quiz I can prevent antibiotic-resistant infections when I: (hint: More than one may apply) 1. Don t take an antibiotic for a viral infection 2. Don t save an antibiotic for the next time I am sick 3. Don t take an antibiotic prescribed for someone else 4. Take my antibiotic exactly as my healthcare provider tells me 7

8 Get Smart Antibiotics Quiz What can happen if I get an antibiotic-resistant infection? (hint: More than one may apply) 1. I may have a longer-lasting illness 2. I may have to visit my doctor more 3. I may require hospitalization 4. I may need more costly medicine that may cause side effects 8

9 Get Smart Antibiotics Quiz Alexander Fleming discovered the first antibiotic in What was the antibiotic named? 1. Mold 2. Penicillin 3. Vancomycin 4. Doxycycline 9

10 Get Smart Antibiotics Quiz Antibiotic resistance has been called one of the world s most pressing public health problems. 1. True 2. False 10

11 What about you? 1. Have you ever taken an antibiotic? 2. Have you ever asked for an antibiotic for yourself or a family member? 3. Have you ever had an adverse reaction to an antibiotic? (e.g., C. diff, allergic reaction, nephrotoxicity) 4. Have you ever had an infection with a multidrug-resistant organism like MRSA? 5. Have you heard of antibiotic stewardship? 11

12 Today s Objectives Antibiotic Stewardship 1. What? 2. Why? 3. When? 4. Where? 5. How? 6. Who? 12

13 13 Antibiotic vs. Antimicrobial??

14 Antibiotic Stewardship: What? What is antibiotic stewardship? Coordinated interventions designed to improve and measure appropriate use of antibiotics by promoting the selection of optimal antibiotic drug regimen, dose, duration of therapy, and route of administration. Coordinated program that promotes the appropriate use of antibiotics, improves patient outcomes, reduces antibiotic resistance, and decreases the spread of infections caused by multidrug-resistant organisms

15 Antibiotic Stewardship: What? The 4 D s of optimal antimicrobial therapy 1. Drug 2. Dose 3. De-escalation 4. Duration of therapy 15

16 Antibiotic Stewardship: Why? 20-50% of antibiotics prescribed in acute care hospitals are either unnecessary or inappropriate 40-75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate 30-50% of antibiotics prescribed in outpatient settings may be unnecessary or inappropriate Inappropriate antibiotic use contributes to Clostridium difficile and Carbapenem-resistant Enterobacteriaceae (CRE) infections, which are considered urgent threats by the CDC 16

17 resistance/about.html 17

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19 Four Core Actions to Fight Resistance esistance/about.html 19

20 Antibiotic Stewardship: When? Brief History Lesson! 1928: Alexander Fleming accidentally discovers penicillin 1940: Antibiotic resistance to penicillin identified Antimicrobial Stewardship first coined in McGowan JE JR and Gerding DN. Does antibiotic restriction prevent resistance? New Horiz Aug; 4(3):

21 Antibiotic Stewardship: When? June 2016: CMS issues proposed rule requiring antibiotic stewardship in hospitals (not final) January 1, 2017: Joint Commission Antimicrobial Stewardship Standard effective November 28, 2017: CMS Regulation effective requiring nursing homes to have an antibiotic stewardship program 21

22 Antibiotic Stewardship: Where? Public Health Clinics Residential Settings All Healthcare settings Dialysis Center Home Health YOU Physician Practices Outpatient Clinics Urgent Care Pharmacies Dental Practices 22

23 Antibiotic Stewardship: How? CDC s Core Elements: Hospitals & NHs 1. Leadership Commitment 2. Accountability 3. Drug Expertise 4. Action 5. Tracking 6. Reporting 7. Education CDC s Core Elements: Outpatient 1. Commitment 2. Action 3. Tracking & Reporting 4. Education & Expertise

24 Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep 2016;65(No. RR-6):

25 The Core Elements of Outpatient Antibiotic Stewardship Commitment: demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety; Action for policy and practice: implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed; Tracking and Reporting: monitor antibiotic prescribing practices and offer regular feedback to clinicians or have clinicians assess their own antibiotic use; Education and Expertise: Provide educational resources to clinicians and patients on antibiotic prescribing, and ensure access to needed expertise on antibiotic prescribing.

26 Commitment Demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety by doing one of the following: Clinicians Write and display public commitments in support of antibiotic stewardship Organizational Leadership Identify a single leader to direct antibiotic stewardship activities within a facility Include stewardship-related duties in position descriptions or job evaluation criteria Communicate with all clinic staff to set patient expectations

27 Public Commitment Posters Simple intervention: poster-placed in exam rooms with clinician picture and commitment to use antibiotics appropriately Randomized-controlled trial Principle of behavioral science: desire to be consistent with previous commitments Behavioral nudge to make the right choice As your doctors, we promise to treat your illness in the best way possible. We are also dedicated to avoid prescribing antibiotics when they are likely do to more harm than good. Adjusted absolute reduction in inappropriate antibiotic prescribing: - 20% compared to controls, p=0.02 Meeker et al. JAMA Intern Med. 2014;174(3):

28 HQI Commitment Poster

29 Action Implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed Clinicians Use evidence-based diagnostic criteria and treatment recommendations Use delayed prescribing practices or watchful waiting, when appropriate Organizational Leadership Provide communications skills training for clinicians Require explicit written justification in the medical record for nonrecommended antibiotic prescribing Provide support for clinical decisions Use call centers, nurse hotlines, or pharmacist consultations as triage systems to prevent unnecessary visits

30 Tracking and Reporting Monitor antibiotic prescribing practices and offer regular feedback to clinicians or have clinicians assess their own antibiotic prescribing practices themselves Clinicians Self-evaluate antibiotic prescribing practices Participate in continuing medical education and quality improvement activities to track and improve antibiotic prescribing Organizational Leadership Implement at least one antibiotic prescribing tracking and reporting system Assess and share performance on quality measures and established reduction goals addressing appropriate antibiotic prescribing from health care plans and payers

31 Tracking and Reporting with Peer Comparisons Effective feedback interventions often include peer performance comparisons a. Comparing clinician s antibiotic selection patterns for respiratory conditions to colleagues performance 1 a. Led to increased use of guideline recommended agents b. Comparing clinician s percentage of inappropriate antibiotic prescribing for acute respiratory conditions to topperformers in their practice 2 a. Led to decreased inappropriate antibiotic prescribing for acute respiratory infections that should not be treated with antibiotics (e.g. colds and acute bronchitis) c. Notifying clinicians that they prescribe more antibiotics than 80% of their peers, based on the percentage all visits leading to antibiotic prescriptions 3 a. Led to decreased overall antibiotic prescribing and costsavings 1. Gerber. JAMA 2013; 309(22): Meeker et al. JAMA 2016;315(6): Hallsworth et al. Lancet 2016; 387(10029):

32 Education and Expertise Provide educational resources to clinicians and patients on antibiotic prescribing and ensure access to needed expertise on optimizing antibiotic prescribing. Clinicians Organizational Leadership Use effective communications strategies to educate patients about when antibiotics are and are not needed Educate about the potential harms of antibiotic treatment Provide patient education materials Provide face-to-face educational training (academic detailing) Provide continuing education activities for clinicians Ensure timely access to persons with expertise

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35 35 Antibiotic Stewardship: Who?

36 What is HQI s involvement? Maryland CAAUSE: Campaign for Appropriate Antibiotic Use Formed: January 2016 Objective: To encourage proper antibiotic use and decrease the rates of drug resistance in MD by promoting antibiotic stewardship across the healthcare spectrum Virginia Virginia State wide Antibiotic Stewardship Campaign Planning work group of the Virginia HAI Advisory Council Statewide kickoff February 1, 2017 Reduce multidrug-resistant organisms across the healthcare spectrum through antibiotic stewardship 36

37 What is HQI s involvement? Regional efforts Affinity Group Multidisciplinary committee of subject matter experts Outpatient Focus 37 Implementing the Core Elements of Outpatient Antibiotic Stewardship in: Ambulatory Surgery Centers, Emergency Departments, Dialysis facilities, Outpatient clinics, Outpatient pharmacies, Pharmacy-based clinics, Physician offices, Public health clinics, and Urgent care centers In development!

38 Discussion Is patient education on appropriate antibiotic use needed? How do you recommend reaching patients with appropriate antibiotic use messaging? 38

39 Let s Review 1. Antibiotics fight infections caused by: (Antibiotics, Bacteria, Viruses) 2. T/F: Bacteria are germs that cause colds and flu. 3. Which of these illnesses should be treated with antibiotics? (Runny nose, The Flu, Cold, Strep Throat) 4. T/F: Bacteria that cause infections can become resistant to antibiotics. 5. I can prevent antibiotic-resistant infections when I: (Don t take an antibiotic for virus, Don t save an antibiotic for the next time, Don t take someone else s antibiotic, Take my antibiotic exactly as my provider tells me) 6. What can happen if I get an antibiotic-resistant infection (Longer illness, More doctor visits, Hospitalization, More expensive treatment) 7. Alexander Fleming discovered the first antibiotic in What was the antibiotic named? 8. T/F: Antibiotic resistance has been called one of the world s most pressing public health problems. 39

40 Antibiotic Stewardship: WHY? 40 This material was prepared by Health Quality Innovators (HQI), the Medicare Quality Innovation Network- Quality Improvement Organization for Maryland and Virginia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HQI 11SOW

41 Contact Information Deb Smith HQI Improvement Consultant Infection Preventionist