AHRQ Safety Program for Improving Antibiotic Use

1. AHRQ Safety Program for Improving Antibiotic Use Acute Care: Onboarding Call #1

2. Presenter: Sara Cosgrove • Sara Cosgrove, MD, MS • Title: Professor of Medicine, Division of Infectious Diseases, Director, Antimicrobial Stewardship Program, Associate Hospital Epidemiologist • Place of work: Johns Hopkins Hospital • Program email address: • antibioticsafety@jhmi.edu

3. Housekeeping • Keep phone on mute • Use ‘raise hand’ or ‘chat’ feature in WebEx if you need to speak • Hold off most questions until the end during Q&A • Participate when asked

4. Objectives of Onboarding Call #1 • Understand the goals of the AHRQ Safety Program for Improving Antibiotic Use • Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program • Understand the timeline and components of the acute care educational toolkit • Learn the objectives and timeline for the AHRQ Safety Program

5. Goals of the Program

6. AHRQ Safety Program for Improving Antibiotic Use • A quality improvement collaborative to improve antibiotic use across healthcare • Program targets 3 settings • Acute Care • Long-term Care • Ambulatory Care • Educational content includes: Clinical (evidence-based approaches) Cultural interventions (CUSP)

7. Integrating Two Important Concepts Technical Training Adaptive Training

8. Expected Outcomes of Program • Improved safety culture • Enhanced teamwork and communication • Reduction in suboptimal antibiotic usage • Improved antibiotic decision-making • Reduction in Clostridium difficile infections • Improved provider, patient, and family satisfaction

9. Benefits to Participants • Technical assistance for Antibiotic Stewardship programs • Access to CUSP (and teaching/coaching webinars) • Networking on regional and national levels • Compliance with The Joint Commission Antimicrobial Stewardship Standard • Access to a comprehensive toolkit

10. Objectives • Understand the goals of the AHRQ Safety Program for Improving Antibiotic Use • Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program • Understand the timeline and components of the acute care educational toolkit • Learn the objectives and timeline for the AHRQ Safety Program

11. The Joint Commission Antimicrobial Stewardship Standard 8 Required Components • Antibiotic Stewardship established as an organizational priority • Education of staff and licensed independent practitioners on antibiotic use and stewardship • Education of patients and families • Antibiotic Stewardship program in place consisting of an Infectious Diseases physician, pharmacist, infection preventionist, prescriber • Antibiotic Stewardship program includes CDC core elements

12. The Joint Commission Antimicrobial Stewardship Standard 8 Required Components • 6. AS program uses of organization-approved multidisciplinary protocols • Guidelines for antibiotic use • Re-evaluation of and feedback to providers regarding antibiotic prescriptions • Antibiotic time out • 7. Hospital collects, analyzes, and reports data on its ASP • 8. Hospital takes action on improvement opportunities identified by its ASP

13. Objectives • Understand the goals of the AHRQ Safety Program for Improving Antibiotic Use • Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program • Understand the timeline and components of the acute care educational toolkit • Learn the objectives and timeline for the AHRQ Safety Program

14. Educational Toolkit • A series of technical and adaptive eLearning modules that will be reviewed via webinars. • Webinars will be held 1-2 times per month.

15. Participant Overview • With existing AS programs, there will be 3 levels of participants— • Antibiotic Stewardship team • Unit champions (e.g., physician, pharmacist, and nurse lead) • Frontline staff • WithOUT existing AS programs, the institution should identify physician and pharmacist leadership to form the backbone of the stewardship team

16. Objectives • Understand the goals of the AHRQ Safety Program for Improving Antibiotic Use • Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program • Understand the timeline and components of the acute care educational toolkit • Learn the objectives and timeline for the AHRQ Safety Program

17. Onboarding Call #2 Antibiotic Stewardship Team April 2017 Apply the Four Moments of Antibiotic Decision-Making Understand how the CUSP approach can improve safety culture Understand how to use the “Team Antibiotic Review Form” to review antibiotic use with frontline staff Understand how to access data and upload data on the AHRQ Safety Program website

18. Antibiotic Stewardship Program (ASP) Development Antibiotic Stewardship Team May 2017 Understand the key personnel for developing an ASP Understand how to work with a senior executive to further program goals Discuss the pros and cons of common ASP interventions Discuss the evaluation metrics for ASPs Understand the steps involved in establishing an ASP

19. Improving Antibiotic Use is a Patient Safety Issue (CUSP 1) AS Team, Unit Champions, Frontline staff May 2017 Discuss the potential harm associated with antibiotic use Understand that patient harm is largely preventable Understand that change efforts often require a focus on systems, not individuals Recognize the principals involved in safe design Understand the importance of diverse input to prevent harm

20. Behavior Change Theory for Antibiotic Stewardship Leaders AS Team June 2017 Understand what motivates health care providers to prescribe antibiotics Understand basic theories regarding implementation science and organizational change to implement AS interventions and to change prescribing habits Understand successful AS behavior interventions in the acute care setting

21. Identifying Targets for Improving Antibiotic Use (CUSP 2) AS Team, Unit Champions, Frontline staff June 2017 Understand how to identify patient safety risks in their clinical areas Understand how to be proactive in asking staff how the next patient will be harmed Understand how to leverage frontline wisdom to guide safety improvement efforts Month:

22. Improving Antibiotic Use by Learning from Defects (CUSP 3) AS Team, Unit Champions, Frontline staff July 2017 Understand how to identify the relevant system factors related to defects in a system Develop interventions to reduce future risk Ensure that interventions are effectively addressing defects related to antibiotic prescribing

23. Improving Teamwork and Communication Around Antibiotic Prescribing (CUSP 4) AS Team, Unit Champions, Frontline staff July 2017 Understand the importance of seeking input from all team members when making antibiotic prescribing decisions Understand how to use available AHRQ Safety Tools to improve communication related to The Four Moments of Antibiotic Decision-Making Understand how to effectively communicate potential harm antibiotics can cause with patients and other health care providers

24. The Team Approach to Stewardship of Asymptomatic Bacteriuria and Urinary Tract Infections AS Team, Unit Champions, Frontline staff August 2017 Understand how to distinguish asymptomatic bacteriuria, cystitis, and pyelonephritis Develop empiric treatment recommendations for UTIs that are institution specific and minimize adverse events Discuss opportunities for de-escalation of antibiotic therapy for UTIs after additional clinical data are available Discuss reasonable durations of antibiotic therapy for UTIs Discuss challenges and ambiguities in developing and executing a standardized approach to the management of asymptomatic bacteriuria and urinary tract infections

25. Additional Syndrome-Specific Modules

26. Coaching Call About Team-Based Stewardship Implementation AS Team, Unit Champions, Frontline staff February 2018 Discuss barriers to and potential mitigation strategies for implementation of team-based stewardship interventions

27. Sustaining Antibiotic Stewardship Efforts ASP team, unit champions, frontline staff March 2018 Understand the need for stewardship interventions to be sustained to have a continued effect Discuss approaches for identifying new stewardship targets Discuss personnel and resources necessary for a stewardship program to successfully be sustained

28. Additional Educational Material • Pamphlets • Posters • Antibiotic time-out tool • Team Antibiotic Review Form • Fast fact sheets

29. Benefit Summary • Education for ASPs and frontline providers in approaches to improve antibiotics use • Assistance with addressing the behavior and cultural drivers of antibiotic prescribing • Approaches to improve teamwork related to antibiotic prescribing • Access to experts and peers to enhance learning and collaboration • Access to materials and approaches to ensure compliance with The Joint Commission Antimicrobial Stewardship Standard

30. Type in your questions using “Chat” Questions

31. Next Steps • Onboarding 1 WebEx call • Onboarding 2 WebEx call • Questions? antibioticsafety@jhmi.edu