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University of Missouri Antimicrobial Stewardship Program : Patient Safety and NPSG Compliance Performance Improvement Leadership Develop Program University.

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Presentation on theme: "University of Missouri Antimicrobial Stewardship Program : Patient Safety and NPSG Compliance Performance Improvement Leadership Develop Program University."— Presentation transcript:

1 University of Missouri Antimicrobial Stewardship Program : Patient Safety and NPSG Compliance Performance Improvement Leadership Develop Program University of Missouri – Columbia February 19, 2010

2 Team Members Joe Cameron, Pharm.D., BCPS Gordon Christensen, MD Ed Ege, Pharm.D. Stephanie Lumley-Hemme, RPh Jennifer Meyer, Pharm.D., BCPS Stevan Whitt, MD

3 Focus Area With the arrival of the Centers for Medicare & Medicaid's no-pay rules, The Joint Commission's National Patient Safety Goals, and the ever-growing emphasis on quality improvement of patient care, prevention has become the standard of care. Participation in multiple quality improvement, automated data surveillance, and antimicrobial stewardship programs have garnered successes for hospitals in terms of improving systems, and in turn care and cost.

4 AIM Statement University of Missouri Hospital aims to implement a process for monitoring and an intervention protocol intended to standardize the use of evidence based antibiotic regimens in the adult surgical intensive care unit. The process starts with a list of new antibiotic orders and a daily culture and sensitivity report from the lab. The process ends with conclusion of antibiotic therapy

5 AIM Statement Our goal is to standardize empiric antibiotic therapy Our secondary outcomes include: improving patient outcomes, decreasing duration of antibiotic therapy, containing antibiotic costs, and decreasing antibiotic resistance and related adverse reactions compared to current practice.

6 Institutional Strategic Goals National Patient Safety Goal 7 : Reduce the risk of health care associated infections New standards for 2009 ▫NPSG : Implement evidence-based practices to prevent health care associated infections due to multiple drug-resistant organisms in acute care hospitals. ▫NPSG : Implement best practices or evidence- based guidelines to prevent central line-associated bloodstream infections. ▫NPSG : Implement best practices for preventing surgical site infections.

7 Institutional Strategic Goals Diagnosis Driven Therapy Uniformity in Prescribing Practices Cost Avoidance Education

8 Project Timeline ECOMS Initial Approval ID Acceptance Data analysis and modification SICU Intial Acceptance Presentation and Implementation of Program August 2009 New Process Development Lab Report Order Sheet Creation with ID Current Process Evaluation ECOMS Approval to move forward IV to PO Conversion Policy Preliminary Data Discussion with PowerChart Documentation Process Modification and Initiation Feb 2010 Jan 2010 Dec 2009 Nov 2009 Oct 2009 Sept 2009

9 Current Process Continued on Next Slide

10 Current Process

11 Fishbone Diagram

12 Upstream Stakeholders Point of Change Stakeholders Downstream Stakeholders Patients Administration Pharmacy ICU Physicians Attendings Residents Infectious Disease Pathology IT Dept. Pharmacy Infection Control Units throughout hospital Pharmacy Stakeholders

13 Interventions Considered Strategy 1Strategy 2 & 3 Active Intervention and Feedback Location Based Patient Based Organism Based Prior-authorization ▫ID Physician or Pharmacist with authority Restricted Formulary ▫Partially implemented, no authority in Pharmacy Education ▫Driven by Attending Physicians

14 Suggested Pathway Continued on Next Slide Yes No

15 Suggested Pathway Continued on Next Slide No Yes

16 Suggested Pathway No Yes

17 Key Driver Diagram

18 Order Sheets

19 Order Sheet

20 Microbiology Reports

21

22 Measurements Diagnosis Stated / Use of Preprinted Order Set >75% De-escalation >75% IV to PO Conversion >75%

23 Baseline Data (2 Weeks) Diagnosis Stated ▫Zero (0%) Patients in SICU ▫21 Patients Antibiotics Prescribed ▫37 Antibiotics One Time Dose (Pre-op) ▫4 Antibiotics De-escalation ▫2 Accomplished (40%) ▫3 Missed IV to PO Conversion ▫None (0%)

24 Process and Outcomes Indicators Outcome Indicators ▫Increased knowledge of appropriate therapy for common infectious diagnoses throughout the institution.  Bacteremia, Pneumonia, and Intra-abdominal Infections ▫Compliance with JCAHO NPSG 7 Process Indicators ▫De-escalation of therapy when appropriate ▫IV to PO Conversion

25 Anticipated Return on Investment / Benefits Realized Increased resident understanding of appropriate empiric evidence based therapy and de- escalation Consistent management of patient specific disease states Decreased development of multi-drug resistant organisms Decreased medication expenditure

26 Lessons Learned Health care team acceptance Analysis of current practice Prediction of program implementation Process improvement application

27 Next Steps Encompass all intensive care units Education of Pharmacists, Nurses, and Physicians Increase number of disease state protocols Increase roll out to all of institution Successful reduction in multi-drug resistant organisms Decreased length of antibiotic therapy and potentially patient stay

28 Questions? Joe Cameron Ed Ege Stephanie Lumley-Hemme Jennifer Meyer

29 Thank You!


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