MHA/OHA HIIN Antibiotic Stewardship/MDRO Collaborative

Transcription

1 MHA/OHA HIIN Antibiotic Stewardship/MDRO Collaborative Place picture here Nov. 14, 2017

2 Reminders For best sound quality, dial in at and enter code Please use the chat box to ask questions! Please note this webinar is being recorded.

3 Housekeeping Education Credit Nursing Education Credit 1 hour Pharmacy Education Credit 0.1

4 Agenda Welcome Presentation: Sanford Bemidji Medical Center Antibiotic Stewardship Program Stefani Anderson, BSN, RN, PHN, CIC & Matt Webb, Pharm.D, BCPS Questions/discussion Resources & ASP 101 reminders Wrap-up

5 Sanford Bemidji Medical Center Antibiotic Stewardship Program (ASP) Stefani S. Anderson BSN, RN, PHN, CIC Matt Webb, Pharm.D., BCPS

6 Sanford Health of Northern Minnesota 118-bed regional medical center based in Bemidji, Minnesota. 78-bed skilled nursing home Home care and hospice 25-bed critical access hospital 37 Ambulatory clinics

7 Sanford Health of Northern Minnesota ASP Program and History Our program began in 2015 Team members include Pharmacy, Chief Medical Officer, Infectious Disease Physician, Infection Control Specialist, Quality, and Microbiology. Meet every other month Bemidji ASP reports to the Enterprise ASP committee as well as the local Pharmacy and Therapeutics (P&T) Early initiatives included Incorporation of antimicrobial review into clinical pharmacist workflow Training pharmacists Provider education about ASP Determining committee structure and reporting Garnering administrative support

8 ASP Regulatory Entities Joint Commission Centers for Medicare and Medicaid Services (CMS) NHSN Antimicrobial Usage (AU) and Antimicrobial Use and Resistance (AUR)

9 What is antimicrobial stewardship? Infectious Disease Society of America (IDSA) defines antimicrobial stewardship as coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration. Can be practiced in all healthcare settings as well as on an individual and system wide level. Often a collaborative effort from providers, pharmacists, microbiologists, infection control, and information technologists.

10 Why is it important? Antibiotics are prescribed unnecessarily or inappropriately % of the time in United States acute care hospitals. This can lead to antimicrobial resistance which is a growing problem and serious threat to our society s collective health. About 23,000 people die as a result of resistant organism each year.

11 IDSA Antimicrobial Stewardship Targets Discontinue antimicrobials when no clear evidence of infection Adjust antimicrobial regimens to account for community acquired vs healthcare associated infection Recommend guideline-based empiric therapy and definitive therapy when pathogen is known De-escalate treatment to the narrowest spectrum drug(s) they can give to accomplish the goal Set an appropriate duration (stop date) for antibiotics Transition from intravenous to oral therapy when able

12 Sanford Bemidji ASP

13 Data Definitions Days of Therapy (DOT)/1000 days present NHSN numerator: Inpatient locations, facility-wide inpatient, and specific outpatient acute care settings Standard Antibiotic Administration Ratio (SAAR) national benchmark not available until NHSN submission

14 Sanford Bemidji ASP Projects Establish local ASP committee with leadership support Educate pharmacists Educate providers Develop patient review plan with ID MD DUEs Vancomycin Fluoroquinolones for UTI

15 Daily Workflow Pharmacists Decentralized clinical pharmacists available Monday through Friday ASP is one of many responsibilities Review all patients on antimicrobials for appropriateness (drug, dose, route, duration) Infectious Disease Physician Communicates daily via inbox and detailed conversations regarding high-risk patients

16 FY17 Goals Improve patient outcomes Reduce resistance Healthcare-associated Clostridium difficile Hospital survival Length of stay Reduce 30-day readmission incidence Pneumonia Sepsis Reduce carbapenem use Reduce quinolone use

17 Data Collection

18 Statistics # of ASP ivents By Month = Bemidji Total Month

19 Required Indications Within Drug Order Carbapenems/ Meropenem Piperacillin/ Tazobactam Quinolones/ Levofloxacin

20 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 DOT/1000 Pt Days 600 a Facility-Wide Antibiotic DOT/1000 Patient Days = Bemidji Month

21 Outcomes Pneumonia and Sepsis

22 PNEUMONIA

23 Hospital Encounters - Pneumonia as Principal Diagnosis at Discharge

24 30-day Readmission- Pneumonia

25 % Hospital Mortality 10% Pneumonia - Hospital Mortality 9% 8% 7% 6% Pneumonia - SANFORD BEMIDJI MEDICAL CENTER - N 5% 5% Pneumonia - SANFORD BISMARCK MEDICAL CTR - N 4% 3% 2% 4% 3% 3% 3% 3% 2% 4% 4% 3% 4% 3% Pneumonia - SANFORD MEDICAL CENTER FARGO - N Pneumonia - SANFORD USD MEDICAL CENTER - N 1% 1% 1% 0% Fiscal Year

26 Avg LOS Pneumonia - Avg LOS Pneumonia - SANFORD BEMIDJI MEDICAL CENTER Pneumonia - SANFORD BISMARCK MEDICAL CTR Pneumonia - SANFORD MEDICAL CENTER FARGO Pneumonia - SANFORD USD MEDICAL CENTER Fiscal Year

27 SEPSIS

28 # of Hospital Encounters # Hospital Encounters - Sepsis as Principal Diagnosis at Discharge Sepsis - SANFORD BEMIDJI MEDICAL CENTER Sepsis - SANFORD BISMARCK MEDICAL CTR 300 Sepsis - SANFORD MEDICAL CENTER FARGO 200 Sepsis - SANFORD USD MEDICAL CENTER Fiscal Year

29 30d Readmit % 50.0% 45.0% 30-day Readmission- Sepsis 40.0% 35.0% 30.0% 25.0% 20.0% SANFORD BEMIDJI MEDICAL CENTER - N SANFORD BISMARCK MEDICAL CTR - N SANFORD MEDICAL CENTER FARGO - Y 15.0% 10.0% 5.0% 0.0% 7.6% 5.3% 5.9% 4.3% 5.3% 3.6% 3.4% 4.2% Fiscal Year SANFORD USD MEDICAL CENTER - Y

30 % Hospital Mortality 20% Sepsis - Hospital Mortality 18% 16% 15% 14% 13% 14% 12% 12% Sepsis - SANFORD BEMIDJI MEDICAL CENTER - N 10% 10% 10% Sepsis - SANFORD BISMARCK MEDICAL CTR - N 8% 6% 6% Sepsis - SANFORD MEDICAL CENTER FARGO - N 4% 4% Sepsis - SANFORD USD MEDICAL CENTER - N 2% 0% Fiscal Year

31 Avg LOS Sepsis - Avg LOS Sepsis - SANFORD BEMIDJI MEDICAL CENTER Sepsis - SANFORD BISMARCK MEDICAL CTR Sepsis - SANFORD MEDICAL CENTER FARGO 2.00 Sepsis - SANFORD USD MEDICAL CENTER Fiscal Year

32 Ordersets and Protocols

33 a

34 a

35 a

36 Cost Analysis

37 Year-end total coming to July meeting as of March 2017 High cost antibiotic targets next year Zosyn Daptomycin Micafungin

38 $17,936, 3% $28,831, 6% $62,523, 12% $117,658, 23% Daptomycin $516K $7,500, 1% $417, 0% $281,376, 55% Jul 2016 May 2017 PHARMACEUTICAL SERVICES SMC PHARMACY FGO PHARMACEUTICAL SERVICES SBK PHARMACEUTICAL SERVICES SMB PHARMACY FGO SU $4,89 2, 3% $3,159, 2% Ertapenem $164K $4,876, 3% $2,291, 1% $19,17 5, $16,596 12%, 10% $113,309, 69% PHARMACEUTICAL SERVICES SMC PHARMACY FGO PHARMACEUTICAL SERVICES SBK PHARMACEUTICAL SERVICES SMB PHARMACY FGO SU $7,855, 1% $9,881, 2% $38,518, 6% $63,388, 10% $289,535, 45% Zosyn $647K $2,619, 0% $235,205, 36% PHARMACY ADN PHARMACEUTICAL SERVICES SMC PHARMACY FGO PHARMACEUTICAL SERVICES SBK PHARMACEUTICAL SERVICES SMB a PHARMACY FGO SU PHARMACY ADN $415, 0% $367, 0% $19,039, 19% $26,585, 26% Micafungin $102K $123, 0% $56,267, 55% PHARMACY ADN PHARMACEUTICAL SERVICES SMC PHARMACY FGO PHARMACEUTICAL SERVICES SBK PHARMACEUTICAL SERVICES SMB PHARMACY FGO SU PHARMACY ADN

39 ASP Response

40 Engagement Sanford-wide ASP participation Leadership support throughout Sanford Local executive leadership support Financial support

41 Successes Decreased carbapenem use Allocated ID MD time to ASP ASP tool in Epic ASP related data / reports

42 Barriers Antibiotic-related order set uptake Expanding ASP to ambulatory clinics

43 Additional Projects Procalcitonin (PCT) Lower respiratory tract infections ICU patients with sepsis/severe sepsis Ambulatory ASP DUEs Collaboration with Long-term Care facilities

44 Recommendation ID involvement and accountability ASP data presented to relevant committees Dedicated time for program Data collection to support program

45 FY18 Goals Reducing Zosyn by 15% Continue expanding required indications for antibiotics Complete UTI fluoroquinolone DUE for select ambulatory clinics

46 References Barlam, T, et al. (2016). Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Disease Society for Healthcare Epidemiology of America. Clinical Infectious Disease, 62(10), e Centers for Disease Control and Prevention. (2017). Checklist for Core Elements of Hospital Antibiotic Stewardship Programs. Retrieved from National Quality Form. (2016). National Quality Partners Playbook: Antibiotic Stewardship in Acute Care. Retrieved from ook Antibiotic_Stewardship_in_Acute_Care.aspx The Joint Commission. (2016). Joint Commission Perspectives, 36(7), 1-8.

47 Resources & ASP 101 Reminders Place picture here

48 U.S. Antibiotic Awareness Week Nov #BeAntibioticsAware Stakeholder toolkit now available! Thursday, Nov CDC & Federal Office of Rural Health Policy webinar on ASP in CAH

49 ASP 101 Reminders

50 ASP 101 Resources CDC Core Elements 5 & 6 Homework Review ASP Toolkit for Rural and Critical Access Hospitals, pages Action Item: create an antibiotic use report or scorecard on at least one antibiotic that is being tracked in the facility. Action Item: Determine to how and with what frequency the antibiogram will be shared with all prescribers in the facility Action item: Determine how and with what frequency prescribers will receive direct, personalized communication about how they can improve their antibiotic prescribing. Supplemental Resources Sample Antibiotic Stewardship Scorecard hips/passport/documents/ihi%20anti biotic%20stewardship%20expedition %20- %20Session%205%20Handouts.pdf NQF Core Elements Playbook: pages ions/2016/05/national_quality_partn ers_playbook Antibiotic_Stewardshi p_in_acute_care.aspx CDC Strategies to Assess Antibiotic Use in Hospitals: care/pdfs/strategies-to-assessantibiotic-use-in-hospitals-508.pdf

51 Thank you for joining us! Next Webinar: ASP Education Strategies: Challenges & Successes Tuesday, Dec. 12 at 11:30am CST/ 12:30pm EST Register online: