Antibiotic Stewardship Discussion: Is your facility on track?

1. More Discussion on Antibiotic Stewardship Is your facility on track? February 14, 2018 Presented by Marilee Johnson, MBA, MT (ASCP) Technical Advisor, Infection Prevention 3/14/2018 1

2. Happy Valentine’s Day!

3. Agenda • Electronic Re-Consent Instructions • Annual Survey Instructions • Remember Your Monthly Reporting Plan • Sams card application • Discussion on Antibiotic Stewardship

4. Electronic Consent Instructions • Log into NHSN https://sams.cdc.gov • Click Reporting, Alerts, Click the hyperlink in the text “click here” http://www.cdc.gov/nhsn/PDFs/QA-NewFacilities.pdf http://www.cdc.gov/nhsn/PDFs/NHSN_ConsentAgreementQA.pdf If you have questions about NHSN, please contact nhsn@cdc.gov. For information on the NHSN, please visit the member's web site at http://www.cdc.gov/nhsn

5. Electronic Consent

6. Electronic Consent √

7. New NHSN Survey Required Download these instructions!! https://www.cdc.gov/nhsn/forms/instr/57.137-toi-annual-facility-survey.pdf

8. Print NHSN Survey Form

9. Question # 3 What is the primary testing method for C. difficileused most often by your facility's laboratory or the outside laboratory where your facility's testing is performed? ***Please contact your lab. You may need to edit last year’s answer. Very important for infection rate calculation.

10. SAMS PROCESS FOR NEW USERS • An active user at your facility, either NHSN administrator or contact person, MUST add the new or back-up user. • If there is no active user, the facility must email a letter to NHSN signed by the Administrator. • All users MUST go through the SAMS proofing Process.

11. IF CDI Project Staff Leaves, the Administrator Will Email NHSN…

12. OR NHSN Administrator can reassign a NEW NHSN Administrator after adding them as a new user This is a MUCH easier way! Please communicate with your staff so there is a consistent surveillance program at your facility.

13. New Reporting Plan Is Required for Each Month If NHSN won’t let you enter your data, you most likely need to create a reporting plan for the month! Add a Monthly Reporting Plan: 21:28-24:43 https://youtu.be/LupvFD10SZo?t=21m28s Click Reporting. Under NHSN Home: Reporting Plan, Add, then Month, Year, then under LabIDEvent Module, Specimen Organism Type, select Cdiff, then Save. Complete this for Jan-March, You can’t set up April until you have submitted the 2017 Annual Survey for NHSN.

14. Recap • Add your Monthly Reporting Plan • Complete the NHSN Survey by March 1st • Complete electronic consent by June 15th • Complete the SAMS application as quickly as possible. Contact the Help Desk at samshelp@cdc.gov or call 1-877-681-2901 • Keep reporting CDI monthly by the 10th

15. This program correlates with the 4th course, “Antibiotic Stewardship” http://qioprogram.org/nursing-home-training-sessions

16. Objectives • Define antibiotic stewardship. • Identify elements of an antibiotic stewardship program. • Describe the role of antibiotic stewardship in preventing the development of antibiotic resistant bacterial infections. • Discuss measures that can be used to determine success of an antibiotic stewardship program

17. What is your Antibiotic Stewardship Vision?

18. “Hoping that scaling back on Antibiotics would work…no one cares but me….hope everyone enjoys a future laden with Cdiff”….Schuchatplans to work hand-in-hand with several major players in the food beverage industry – think Coca-Cola, Pepsi, and Tyson Foods – as well as the Food & Drug Administration to expand antibiotic use in other beverages and make sure, for example, your next can of soda has a label indicating antibiotic content and side effects. “If I had to guess,” said Schuchat, “each 12-oz can of Coke or Pepsi will have 1 gram of vancomycin and 3.375 grams of Zosyn, though we’re still in the early stages” http://gomerblog.com/?s=antibiotic%20stewardship&post_type=post I read it in the tabloids…..

19. ManyToolKits Are Available • Minnesota http://www.health.state.mn.us/divs/idepc/dtopics/antibioticresistance/asp/ltc/index.html • Nebraska https://asap.nebraskamed.com/long-term-care/ • UNC https://nursinghomeinfections.unc.edu/ And many more!!! Analysis Paralysis!

20. Definition Antibiotic stewardship refers to a set of commitments and activities designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.”

21. Yes! • https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilit§483.80(a)(3) An antibiotic §483.80(a)(3) https://www.federalregister.gov/documents/2016/10/04/2016-23503/ medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities

22. State Survey NOTICE • 2 Nursing Home facilities in NC were cited the week of Feb 5th by Division of Health Service Regulation for NOT having an antibiotic stewardship program. • Will you be ready before your next State Survey? • Yes • NO √

23. Readiness On a Scale from 1-10, where are you in your antibiotic stewardship program implementation? Test your readiness using this checklist! https://www.cdc.gov/longtermcare/pdfs/core-elements-antibiotic-stewardship-checklist.pdf

24. DID YOU KNOW? https://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html

25. NHSN Annual Survey Leadership Questions in Annual survey: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/core-elements-linelist.pdf https://www.cdc.gov/nhsn/forms/instr/57.137-toi-annual-facility-survey.pdf

26. NHSN Annual Survey Accountability Question in NHSN Survey: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/core-elements-linelist.pdf https://www.cdc.gov/nhsn/forms/instr/57.137-toi-annual-facility-survey.pdf

27. NHSN Annual SurveyCMS Requirements How NHSN can track your Antibiotic Stewardship Program Requirements https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/core-elements-linelist.pdf https://www.cdc.gov/nhsn/forms/instr/57.137-toi-annual-facility-survey.pdf

28. Reflections • Do you have an Infection Prevention Program that includes Antibiotic Stewardship? • Are you recording incidents and corrective actions taken by the facility • Do you have a designated, trained infection prevention officer? • Is there a pharmacist reviewing the resident’s MR when receiving an antibiotic?

29. Activity #3 (From Training Session)

30. Activity #3 Discussion question: Scenario 1: A new administrator has joined Committed to Quality Nursing Home– how would she know whether this facility made antibiotic stewardship a priority area?

31. Activity #3 Discussion question: Scenario 2: How would staff and providers know a new facility administrator made antibiotic stewardship a priority?

32. Take Home Messages • Antibiotic stewardship helps reduce inappropriate antibiotic use. Inappropriate use causes development of resistant bacteria which can be very difficult and costly to treat. • There are strategies that nursing homes can implement to be good stewards of antibiotics. These strategies can be implemented in a step-wise fashion.

33. Take Home Messages • Everyone in the nursing home plays a role in how antibiotics are used and in preventing antibiotic resistance. • Nursing homes need to work together to support prescribing providers in judiciously using antibiotics. Working to prevent antibiotic resistance will take a degree of vigilance and attention to detail that nursing homes may not feel is in their purview, as they feel that they may not have control over prescribers.

34. Take Home Messages …to work as a team and be effective in preventing resistance and promoting antibiotic stewardship, nursing home leaders will have to understand resistance patterns, and to not present situations in a way to prescribing providers that requests or expects an antibiotic, and make sure that cultures are used and that antibiograms are used to help guide empiric treatment.

35. Questions What are your barriers to Antibiotic Stewardship today?

36. Summary • Nursing Homes are a vital part of the equation • You can take specific steps: • Continue C.diff surveillance/infection control • Ask your lab for an Antibiogram and share with physicians and staff... (register for March 14 shoptalk to learn more!) • Form an interdisciplinary team to create a culture of safe antibiotic use and use one of the many templates available to implement your program • Take the training: http://qioprogram.org/nursing-home-training-sessions

37. Don’t forget to Collect Your Free CEU MetaStar, Inc. is the approved provider of CNE for this activity in a joint-providership with Telligen. • Partial credit may be earned as follows: http://qioprogram.org/exploring-antibiotics-and-their-role-fighting-bacterial-infections

38. Get your Free CEUs! • Complete the training and apply for your CEUs by filling out the online evaluation. https://www.surveygizmo.com/s3/3461504/NH-Online-Training-Session-4-Antibiotic-Stewardship

39. Thank you for partnering with Alliant Quality! Alliant Quality Marilee H. Johnson, MBA, MT (ASCP) Technical Advisor, Infection Prevention 919-695-8331 marilee.johnson@alliantquality.org For More Information Contact:

40. This material prepared by GMCF for Alliant Quality the Medicare Quality Innovation Network – Quality Improvement Organization for Georgia and North Carolina, 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. Publication No.. Publication No. 11SOW-GMCFQIN-C2-18-08