1. The AHRQ Safety Program for Improving Antibiotic Use

2. Presenter — Pranita Tamma
Pranita Tamma, M.D., M.H.S.
Assistant Professor of Pediatrics
Director of Pediatric Antimicrobial Stewardship, Johns Hopkins Hospital
Program address:

3. What is the AHRQ Safety Program?
Collaborative intervention
AHRQ
Johns Hopkins Medicine
NORC
Overarching goal:
To improve antibiotic prescribing practices and assist facilities with implementing effective antibiotic stewardship programs.
The goals of antibiotic stewardship:
To ensure that all patients requiring antibiotics receive the right drug at the right dose and for the right duration.

4. What does the AHRQ Safety Program address?
Addresses both:
Technical aspects
e.g., best practice in antibiotic prescribing for common infectious diseases syndromes
Adaptive aspects
e.g., safety culture, behavior change, teamwork and communication

5. Participating in the AHRQ Safety Program
One year program begins in December 2017
Three month baseline period
Nine month intervention period
No fee to participate
Entire hospitals are invited to participate but individual units within hospitals can also still participate

6. Benefits of Participating
Access to Antibiotic Stewardship experts for coaching and troubleshooting
Monthly interactive webinars
30-60 minutes long
Recorded and posted to the project website for 24/7 access
Slides and facilitator guides available for local use

7. More Benefits of Participating
Access to:
Fast fact sheets and learning modules
Tools to improve antibiotic prescribing practices
Educational material for patients and families
Materials to assist with compliance with The Joint Commission Stewardship Standard

8. Expected Outcomes of Participation
Improve safety culture around antibiotic prescribing
Enhance teamwork and communication among health care workers and between health care workers and patients/families
Reduce unnecessary antibiotic use
Improve antibiotic decision-making by frontline staff
Reduce Clostridium difficile infection rates
Improve compliance with The Joint Commission Antimicrobial Stewardship Standard

9. The Four Moments of Antibiotic Decision-Making
1. Does my patient have an infection that requires antibiotics?
2. Have I ordered appropriate cultures before starting antibiotics? What empiric therapy should I initiate?
3. A day or more has passed. Can I stop antibiotics? Can I narrow therapy or change from IV to oral therapy?
4. What duration of antibiotic therapy is needed for my patient's diagnosis?

10. Acute Care Facilities Webinars: Adaptive Topics
Behavior change theory for antibiotic stewardship leaders
Improving antibiotic use is a patient safety issue
Improving communication and teamwork around antibiotic prescribing
Identifying defects to improve antibiotic use
Improving antibiotic use by learning from defects
Sustaining antibiotic stewardship efforts

11. Acute Care Facilities Webinars: Technical Topics
Antibiotic stewardship program development
Stewardship of asymptomatic bacteriuria and urinary tract infections
Stewardship of community-acquired lower respiratory tract conditions
Stewardship of healthcare-associated and ventilator- associated pneumonia
Stewardship of skin and soft tissue infections
Stewardship of intra-abdominal infections
Stewardship of C. difficile infections

12. Compliments CMS HIIN Initiative
One of the goals of the CMS’s Partnership for Patient’s Hospital Improvement Innovation Network (HIIN) initiative is reduction in C. difficile rates reported to the CDC
Adoption of antibiotic stewardship is one approach suggested to achieve this
The AHRQ Safety Program can help your site develop or improve your stewardship activities and places specific emphasis on approaches to reduce C. difficile LabID events and C. difficile infection

13. Data Required From Participating Hospitals
Monthly data on days of antibiotic therapy per 1,000 days present ← AUR measure
Using NHSN AUR definitions ual/11pscaurcurrent.pdf
Quarterly C. difficile laboratory events per 10,000 patient-days

14. Other Data Required From Participating Hospitals
Completion of:
10 antibiotic review forms per month per unit to identify targets for and track improvement in antibiotic prescribing
Completed by:
ASP and front-line prescribers together
Completion guide available
About 5 minutes per form

15. Team Antibiotic Review Form

16. Other Data Required From Participants
Completion of a survey regarding current antibiotic stewardship practice
Basic information about the facility and current activities in patient safety and antibiotic stewardship
Completion of the Hospital Survey on Patient Safety

17. What Do Participating Hospitals Need to Do?
Identify the antibiotic stewardship team
Identify and engage front-line staff on participating units and services
Participate in monthly webinars with experts
Between webinars, identify antibiotic-related defects and identify solutions, incorporate relevant tools into practice
Submit requested data to the program website

18. Timeline for Participation
Action
Due Date
Complete the Hospital Letter of Commitment
October 15, 2017
Assemble ASP and front-line teams within your hospital
Complete the Data Use Agreement (Optional)
October 31, 2017
Register your team members to use the project data portal
At least one team member attends an online informational webinar
November 2017
Participate in monthly webinars
Beginning December 2017
Regularly meet as a team to implement interventions and monitor performance
December 2017 until the end of project
Complete survey assessments and submit hospital data according to the data collection schedule
Starting
December 2017 until end of project

19. To Learn More and Enroll
Visit our website
Complete the online application on the website
with any questions

20. THANK YOU FOR PARTICIPATING!
Questions
Type in your questions using “Chat” or
Speak up on conference line
THANK YOU FOR PARTICIPATING!

21. Joint Commission Antimicrobial Stewardship Standard
8 Required Components
AS established as an organizational priority
Education of staff and licensed independent practitioners on antibiotic use and stewardship
Education of patients and families
AS program in place consisting of an ID physician, pharmacist(s), Infection Preventionist(s), and Practitioner (depending on availability)
AS program includes CDC core elements
AS program uses organization-approved multidisciplinary protocols
Hospital collects, analyzes, and reports data on its ASP
Hospital takes action on improvement opportunities identified by its ASP