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Clinical Commentary: Multidrug Resistant Bacteria – An Ongoing
Global Healthcare Challenge
Merck Grant ID: AAN151207035508
FINAL OUTCOMES REPORT
Executive Summary (Level 1-2)
Satisfaction• 93% of clinicians would recommend this activity to a colleague• 98% of learners did not perceive any bias • 91% of learners rated educational content as good/excellent
Learning Objectives• 98% of participants strongly agree/agree that they are better able to
meet the learning objectives after completing the activity
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Impact• 93% of learners stated that the activity increased or validated their
competence in practice • 68% of learners will change their practice based on this activity; 35%
plan to change the management and/or treatment of my patients• 47% of learners will seek to address potential barriers to patient access
to therapies
Reach• 5,874 Participants and 4,991 Certificates
• Pharmacist Participants - 4,469• Pharmacist Completers with Certificate - 3,809• MDs, PAs, RNs, & NPs Participants - 1,405• MDs, PAs, RNs, & NPs Completers with Certificate - 1,182
• 62% of participants were pharmacists
Executive Summary (Level 3-4)
Competence• Participants demonstrated improved competence in the selection of
therapy for a theoretical case patient• Learners reported increased confidence across several areas, including
application of local antibiograms and selection of therapy
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Performance and Patient Outcomes• Clinician learners reported an intent to obtain a culture and refer to
their local antibiogram; however, only one-third reported this intent to change
• Of pharmacist learners, 51% plan to collaborate with colleagues to discuss best practices and approaches to dosing and duration of therapy
• These members of the multidisciplinary team plan to implement changes that may optimize antimicrobial therapy and reduce the development of resistance
Knowledge• Participants demonstrated increased awareness of differences in the
definitions of multi-drug resistance• Participants demonstrated increased knowledge of the mechanism of
vancomycin-resistant enterococci
Future Educational Opportunities
Clinician learners are most interested in education on infection control while
pharmacist learners are most interested in antibiotic stewardship
Learners would like more knowledge on the clinical
application of new antimicrobials
Consider case-based activities as learners demonstrated increased competence
with newer therapies based on the faculty discussion on selection of therapy for
diverse patients
Future Educational Opportunities
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Program OverviewOverview: This online clinical commentary reviewed the impact of extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing bacteria and presented comparative data on current and emerging therapies to develop strategies for initial therapy and optimal outcomes.
Intended Audience: This activity intended to educate physicians, nurses, pharmacists, and other clinicians involved in the treatment of multidrug resistant infections.
Activity Date: June 30, 2016Expiration Date: June 30, 2017
Power-Pak C.E. ™ (Pharmacists) - http://www.powerpak.com/course/preamble/113153freeCME (MDs, PAs, RNs, & NPs) - https://learning.freecme.com/a/21674PAgzkgE
Credit: 1.0 AMA PRA Category 1 Credit™ (Physicians), 1.0 CPE contact hour (Pharmacists) and 0.1 IACET contact hour (Nurses)
Sponsored By: The Academy for Continued Healthcare Learning (ACHL)
Funding: Supported by an educational grant from Merck
Faculty
James Lewis, PharmDClinical PharmacistAntimicrobial Management TeamDepartment of Pharmacy ServicesOregon Health & Science UniversityPortland, OR
Carlene A. Muto, MD, MSAssociate ProfessorDepartment of Medicine, Infectious DiseasesUniversity of VirginiaCharlottesville, VA
Participation
Participants: 5874 Certificates: 4991
8%7%
4%2%
62%
10%7%
Clinician TypePhysician
PhysicianAssistantNurse
NursePractitionerPharmacist
Pharmacist Tech
Participation (Cont.)
1%
44%
4%2%2%1%1%
31%
14%
Pharmacy Specialty
Academia/Pharmacy School
Health Systems
Long Term Care/Nursing Home
Managed Care Company
Pharmacuetical Manufacturer
Pharmacy Benefit Manager
Psychiatric Hospital
Retail
Other
*other includes ambulatory care, changing setting, compounding, cardio practice, development inst., info tech pharmacist, med education, mail order, drug wholesale distributor
Participation (Cont.)
12%
9%
50%
8%
7%
4%4% 3% 3%
Clinician Breakdown
Family PracticeUknownOtherInternal MedicineEmergency MedicinePediatricsGeneral PracticeSurgeryPrimary Care
*Other includes cardiologists, podiatrists, dermatologists, psychiatrists, gastroenterologists, radiologists, hospitalists etc.
Learning Objectives
Please rate the following objectives to indicate if you are better able to:
Analysis of Respondents
Rating Scale: 4=Strongly Agree
1=Strongly Disagree
Demonstrate an understanding of the molecular epidemiology of antibiotic resistance in bacterial pathogens
3.41
Summarize the salient features and critical differences amongst available antibiotics and those in development for use against multidrug resistant gram-negative bacteria
3.40
Describe strategies to optimize initial antimicrobial therapy to ensure effectiveness of antibiotics and reduce the development of resistance
3.42
Discuss the interventions with the potential to reduce inappropriate use of antibiotics and improve outcomes in patients with resistant bacterial infections
3.42
N=4,974
Learners Strongly Agree/Agree that all learning objectives were met, with an average rating of
3.41/4.0
Faculty
Faculty Evaluation Analysis of Respondents5 = Excellent, 1 = Poor
James Lewis, PharmD Carlene A. Muto, MD, MS
Ability to effectively convey the subject matter 4.32 4.34
Ability to deliver an objective and balanced presentation 4.34 4.35
Ability to present scientifically rigorous information 4.33 4.34
Expertise on the subject matter 4.37 4.38
N=4,974
The faculty were highly rated across all areas, with an average rating of 4.35/5.0.
Satisfaction
Overall Evaluation Analysis of Respondents5=Excellent, 1=Poor
Quality of educational content 4.30
Usefulness of educational material 4.29
Effectiveness of teaching method used 4.23
Appropriateness and effectiveness of active learning strategies (questions, cases, discussion, etc)
4.27
Usefulness of educational material and active learning strategies were able to support learning with 4.29 and 4.27 out of 5.0 rating
respectively.
Quality of educational content was highly rated at 4.30 out of 5.0
N=4,974
Objectivity & Bias
49%40%
10%
1%0%
20%
40%
60%
80%
100%
Objectivity & Balance
2%
98%
0%
20%
40%
60%
80%
100%
Yes No
Perception of Bias
Activity was viewed as objective, balanced, and non-biased.
N=4,956N=4,989
Question Topic % Change Pharmacist
% Change MD, PA, RN, NP
Q1 Defining multi-drug resistant bacteria 274% 227%
Q2 Mechanisms of resistance 210% 177%Q3 Selection of therapy 124% 207%Q4 Novel therapies 94% 69%
Levels 3-4: Pretest vs. Posttest Summary
23% 31% 38% 47%
86% 96% 85% 91%
22% 31% 28%48%
72%86% 86% 81%
0%
50%
100%
Q1 Q2 Q3 Q4
Pharmacists Pre n=7,638 Pharmacists Post n=3,809MDs, PAs, RNs, & NPs Pre n=1,356 MDs, PAs, RNs, & NPs Post n=1,206
Below is a summary of participant responses, based on questions answered at pre-activity and immediately following the activity.
12% 23%
62%
3%4%
86%
9%1%
0%
25%
50%
75%
100%
A B C D
Pharmacists Pre n=7,638
Post n=3,809
1. Definitions of multi-drug resistant bacteria:
A. Have been standardized by United States and European organizations
B. Vary across hospitalsC. Apply to pathogens that are resistant to one
or more classes of antimicrobialsD. Are consistent across pathogens
Correct responses increased in both groups of learners after participation in the activity, but pharmacists displayed greater improvement. The baseline results from this question are indicative of the inconsistencies in defining
multi-drug resistance across institutions. Increased awareness of the challenges
discussed by the faculty may prompt learners to examine how their respective institution
defines multi-drug resistance.
16% 22%
58%
4%11%
72%
10%
0%
25%
50%
75%
100%
A B C D
MDs, PAs, RNs, & NPs Pre n=1,356
Post n=1,206
Levels 3-4: Pretest vs. Posttest
31%20% 20%
29%
86%
1% 1% 1%0%
25%
50%
75%
100%
A B C D
Pharmacists Pre n=7,638
Post n=3,809
Levels 3-4: Pretest vs. Posttest
2. What is the mechanism of resistance of vancomycin-resistant enterococci?
A. Change in binding siteB. Upregulated efflux pumpsC. Enzymatic degradationD. Outer membrane porin changes
Both groups of learners had low performance on this question around mechanisms of
resistance on the pre-test. However, by the end of the activity, knowledge across both
groups of learners increased with participants providing correct responses 80%
(or greater) of the time.
31%
13%
24% 32%
86%
5% 5% 4%0%
25%
50%
75%
100%
A B C D
MDs, PAs, RNs, & NPs Pre n=1,356
Post n=1,206
18%32% 38%
12%3%
10%
85%
2%0%
25%
50%
75%
100%
A B C D
Pharmacists Pre n=7,638
Post n=3,809
Levels 3-4: Pretest vs. Posttest
3. A 67-year old woman with a history of smoking is admitted from the ED for rapidly progressing pneumonia. Despite therapy, she exhibits worsening signs and is transferred to the ICU. P. aeruginosa is isolated from sputum specimens. What therapy would you select for her?
A. A carbapenemB. Ceftolozane-tazobactamC. Piperacillin-tazobactamD. A quinolone
Both groups of learners demonstrated increased competence in the selection of therapy for this
theoretical patient. Selection of therapy at baseline varied greatly in both sets of learners,
with approximately one-third selecting the newer, yet off-label, approach of using ceftolozane-
tazobactam. The percentage selecting piperacillin-tazobactam increased to
approximately 85%, likely based on the faculty discussion.
16%
39% 28%
17%4% 6%
86%
4%0%
25%
50%
75%
100%
A B C D
MDs, PAs, RNs, & NPs Pre n=1,356
Post n=1,206
12%28%
13%
47%
1% 4% 4%
91%
0%
25%
50%
75%
100%
A B C D
Pharmacists
Pre n=7,638
Post n=3,809
4. Ceftolozane, the new cephalosporin in the combination of ceftolozane-tazobactam, is distinguished from other cephalosporins by its activity against which of the following?
A. Acinetobacter baumanniiB. Klebsiella pneumoniae carbapenemaseC. New Delhi metallo-β-lactamase–producing
EnterobacteriaceaeD. Pseudomonas aeruginosa
The percentage of clinician and pharmacist learners demonstrating increased knowledge of
ceftolozane-tazobactam increased after participation in the activity. The increase was
greater in pharmacists. This increased knowledge may translate into clinical decisions
when selecting therapy.
14%25%
13%
48%
3% 4% 12%
81%
0%
25%
50%
75%
100%
A B C D
MDs, PAs, RNs, & NPs Pre n=1,356
Post n=1,206
Levels 3-4: Pretest vs. Posttest
Confidence: Local Antibiogram Knowledge
How confident are you in your knowledge of the local antibiogram in your institution?
A. Very confident
B. Somewhat confident
C. Minimally confident
D. Not at all confident
Prior to participating in the activity, confidence in their knowledge of local
antibiograms was reported by slightly more than one-half of all learners. After viewing
the faculty discussion on the use of antibiograms to selection therapy, 79% and
82% of clinician and pharmacist learners, respectively, reported being “very” or
“somewhat” confident in their knowledge.
12%
42%31%
15%27%
55%
14%4%
0%
25%
50%
75%
100%
A B C D
Pharmacists
Pre n=7,661
Post n=2,557
13%
44%29%
14%23%
56%
16%5%
0%
25%
50%
75%
100%
A B C D
MDs, PAs, RNs, & NPs Pre n=1,356
Post n=1,180
Confidence: Selection of Therapy
How confident are you in your ability to select therapy for your patients with multi-drug resistant infections?
A. Very confident
B. Somewhat confident
C. Minimally confident
D. Not at all confident
Approximately 55% of clinicians and pharmacists reported being “very” or “somewhat”
confident in their ability to select therapy for their patients with multi-drug resistant
infections at the beginning of the activity. After the activity, confidence levels improved in both target audiences with 82% and 85%
reporting confidence. The faculty case-based discussions on selection of therapy for diverse
patients likely contributed to this improvement in confidence.
11%
44%32%
13%27%
58%
12%3%
0%
25%
50%
75%
100%
A B C D
Pharmacists
Pre n=7,661
Post n=2,557
12%
44%30%
14%23%
59%
14%4%
0%
25%
50%
75%
100%
A B C D
MDs, PAs, RNs, & NPs
Pre n=1,356
Post n=1,180
Confidence: Antimicrobial Therapy Dosing
How confident are you in your ability to determine the appropriate dose and duration of antimicrobial therapy to gain the best outcome and minimize bacterial resistance?
A. Very confident
B. Somewhat confident
C. Minimally confident
D. Not at all confident
Slightly more than one-half of pharmacists and clinicians reported being “very” or “somewhat”
confident in their ability to determine appropriate dosage and duration of
antimicrobial therapy prior to participating in the activity. This self-reported confidence
increased in the clinician (81%) and pharmacist (86%) groups after the activity. Again, the case-
based portion of this activity may have influenced this improvement.
12%
45%30%
13%29%
57%
11%3%
0%
25%
50%
75%
100%
A B C D
Pharmacists
Pre n=7,661
Post n=2,557
12%
44%30%
14%23%
58%
15%4%
0%
25%
50%
75%
100%
A B C D
MDs, PAs, RNs, & NPs
Pre n=1,356
Post n=1,180
Level 4: How Will You Change Your Practice?
14%
17%
19%
21%
29%
E
D
C
B
A
FreeCME
Obtaining a culture and referring to their local antibiogram are the most common approaches employed by these clinicians. However, less than one-
third of participants employ these important aspects to improve patient outcomes in patients with multidrug resistant infection. These data underscore the importance of this activity and warrant additional educational endeavors.
(MDs, PAs, RNs, & NPs) Which of the following strategies do you currently employ to improve outcomes in patients with multidrug resistant infection (check all that apply)?
A. Get a cultureB. Refer to my hospital/institution
antibiogram to determine the susceptibility
C. Continue or change prescribed antimicrobial based on results of culture
D. Gain infectious disease and/or pharmacy input
E. Determine appropriate dose and duration of therapy to gain best outcome and minimize bacterial resistance
N=2,514
Level 4: How Will You Change Your Practice?
5%
25%
24%
46%
D
C
B
A
FreeCME
Clinician learners indicated that they intend to change their practice after participating in this activity. 46% reported plans to increase their knowledge of institutional resistance patterns to aid in choosing empiric treatment. This is in contrast to the low number of
learners who reported referring to their local data before participation.
Additionally, one-quarter intend to determine the appropriate dose and duration of therapy and consult infectious disease or pharmacy experts on difficult to treat multidrug resistant
pathogens for better outcomes
(MDs, PAs, RNs, & NPs) I plan to make changes to my practice based on this activity, by incorporating the following new strategies:
A. Increase my knowledge of institutional resistance patterns to assist in the choice of empiric treatment
B. Determine appropriate dose and duration of therapy to gain best outcome and minimize bacterial resistance
C. Consult infectious disease and/or pharmacy on cases involving difficult to treat multidrug resistant pathogens
D. Other
N=1,180
Level 4: How Will You Change Your Practice?
12%
37%
51%
C
B
A
Power-Pak
Pharmacists also report that they intend to change their practice after participation in the activity.
51% plan to collaborate with colleagues to discuss best practices and approaches to dosing and duration of therapy and 37% intend to consult their colleagues on difficult to treat
multidrug resistant cases.
Taken together, the clinician and pharmacist data indicate that these important members of the multidisciplinary team plan to implement changes that may optimize antimicrobial
therapy and reduce the development of resistance.
(Pharmacists ONLY) I plan to make changes to my practice based on this activity, by incorporating the following new strategies:
A. Collaborate with my clinician colleagues to share best practices to determine appropriate dose and duration of therapy to gain best outcomes while minimizing bacterial resistance
B. Consult infectious disease/control colleagues on cases involving difficult to treat multidrug resistant pathogens to ensure appropriate antimicrobial stewardship and optimal outcomes
C. Other
N=3,381
Levels 3-5: Impact of Activity
Please rate the projected impact of this activity on your knowledge, competence, performance and patient outcomes?
Yes No Change No
This activity increased my knowledge 80% 14% 6%
This activity increased my competence 75% 18% 7%
This activity will improve my performance 69% 23% 8%
This activity will improve my patient outcomes 66% 25% 9%
This activity was highly effective, with 66% indicating it will impact patient outcomes.
N=4,953; a listing of participant comments is included in the appendix
Common themes from participants with respect to knowledge, competence, and performanceKnowledge• Beneficial in healthcare documentation for recognition of errors and discrepancies for flagging and risk management• Learned about new combination antibiotics used for cUTI and pyelonephritis• Use of newer agents and new antibiotics • Better understanding of resistance Competence• Awareness of complications within hospital care and some updates on MDR organisms and tx modalities• Recognize the mechanisms of resistance & use of appropriate empiric and sensitivity-based antibiotics• Better prepared to answer physician questions Performance• Gave me a framework for rational clinical decision making in choosing, dosing, and determining length of treatment with antibiotics• This will help me to identify patients who may need admittance to the hospital. I will also perform more cultures as a result in order to
maximize efficacy and minimize resistance.• Better prepared to make recommendations and appropriate antibiotic selection for multidrug-resistant organisms
Patient Impact
26%
48%
14%
6%6%
Number of patients affected by these changes each month:
0
1-10
11-20
21-50
>50
Changes will impact up to 52,725 patients each month. This assumes data in chart above is representative of all participants (5,874), who indicated their
patient outcomes would be effected as a result of this activity (66%).
Perceived Clinical Barriers
Please indicate any barriers you perceive in implementing these changes.
7%
5%
9%
11%
2%
10%
8%
7%
21%
11%
8%
8%
6%
8%
12%
4%
6%
8%
9%
15%
22%
3%
Cost
Reimbursement/insurance issues
Lack of opportunity (patients)
Lack of experience
Lack of resources (equipment)
Lack of time to assess/counsel patients
Lack of administrative support
Lack of consensus or professional…
No barriers
Patient compliance issues
Other, please specify
Pharmacist MDs, PAs, RNs, & NPs
N=5,559Select all that apply
Of the learners that intend to address barriers to practice,
identified strategies include: seek resources and support, monitor recurrences, and discuss with
colleagues and administration on effective recommendations.
48% of pharmacists and 46% of clinicians indicated that they will
attempt to address these barriers to implement changes.
How Barriers Will Be Addressed (open-ended comments)
• Improve communication and awareness of problem associated with bacterial resistance with patient and hospital
• Continue to educate myself regarding evolving practice standards • Have time to assess/counsel patients, consensus or professional guidelines
and administrative support• Integrate patient education and intervention • Utilizing resources, such as ID specialist and pharmacy for guidance when
needed• Share the information in the activity with our infectious disease doctor to
help implement new policy• Make sure that the patient really understands the importance and use the
method of teach back• Educating the patient about the importance of complying with treatment
protocols
*Please see appendix for comprehensive learner comments
Future Education Considerations
3%
5%
20%
23%
19%
30%
1%
9%
18%
24%
30%
18%
F
E
D
C
B
A
MDs, PAs, RNs, & NPs Pharmacist
Among pharmacists, the top two categories for future education were antimicrobial stewardship and the use of new antimicrobials. Clinicians
viewed infection control as an area they would most like to see also followed by the use of new antimicrobials. These differences are in line with the roles
of pharmacists and other providers in reducing multi-drug resistance.
What topic areas would you like to see in future activities?
A. Antimicrobial stewardship
B. Infection control
C. Use of new antimicrobials
D. Dosing and duration of antimicrobials
E. Clinical trial efficacy and safety data
F. Other
N=5,385
For questions, please contact:Rich KeenanVP, Education DevelopmentAcademy for Continued Healthcare Learning (ACHL)
E: [email protected]: 773-714-0705 ext. 215C: 610-742-0749
Appendix
See Attached PDF Comments
APPENDIX
PowerPak (Pharmacists)
4. Did you perceive any bias or commercialism towards any product or drug in this activity? If yes,
please explain:
Muti drug
No mention of use of antibiotics in food supply as source for growing MDR pathogens
Too much talk about two new combo antibx...makes u wonder
Lecture sponsored by Merck, new drug Ceftolozane; Tazobactam made by Merck
Mildly obvious it was oriented to ceftolazane, but not annoyingly so
Some preference toward Zerbaxa
7. Please rate the projected impact of this activity on your knowledge, competence, performance and
patients’ outcomes in the treatment of multidrug resistant infection:
This activity increased my knowledge. If yes, please describe:
Use of newer agents
Better understand resistance
Learned about new combination antibiotics used for cUTI, pyelonephritis
Learned about a new antibiotic
Would like to do more research and learn more
Newer agents
New antibiotics
8. This activity increased my competence. If yes, please describe:
Better prepared to answer physician questions
9. This activity will improve my performance. If yes, please describe:
Better prepared to make recommendations
I plan on reading more about MDR's and finding a job to use my knowledge
Increased awareness and confidence
Selecting appropriate antibiotics for multidrug‐resistant organisms
10. This activity will improve my patient outcomes. If yes, please describe:
Hopefully patients will be on correct antibiotics for correct duration of time
Better understanding of diagnostics
12. (Pharmacists ONLY) I plan to make changes to my practice based on this activity, by incorporating the following new strategies:
Other, please specify:
Continue to promote stewardship program in our facility Validated my practice Technician Question /return prescription in data review with inappropriate dose /duration Discussion for IC, rate of infusion, Become familiarized with my institution's antibiogram Compound pharmacy strengthening antibiotic stewardship program i work with homeopathics so this was will not help my practice but improve my knowledge as a
pharmacist retail community rph, not involved with treatment decisions formulary consult with clinicians to share best practices community pharmacy you don't have much input into drug selection for MDR infections but I
can watch more closely for patients getting repeat/under dose speak to pharmacist in my area of practice, I do not treat or have direct patient contact Be able to address best practice strategies with colleagues pharmacy technician i plan to make changes in cleaning and awareness Collaborate with my physicians not working Not currently in practice increase my education administrative role vs clinical strict formulary as a retail pharmacist I will verify rx on antibiotics therapy accordingly and counsel pt and dr. Collaborate with prescribers Better knowledge as I work in industry I do not choose therapies updating competence my hospital does not have multidisciplinary approach I am employed at a community pharmacy I don't see patients. But we approve IV antibiotics and sometimes orals. monitor abx usage Assist with evidence based order sets I am in retail pharmacy and i have limited susceptibility information not applicable, not a hospital pharmacist, but topic of interest for discussion to pts in
community setting not part of the determination of therapies implemented. not in practice-regulatory This is already part of current practice
Please identify how you will change your practice as a result of participating in this activity. Please identify how you will change your practice as a result of participating in this activity (select all that apply).
Other, please specify:
we usually don't do IV antibiotics in my practice
inform patients on community acquired drug resistance
better assess the choices of antibiotics prescribed by providers for outpatient usage
not valid for community practice
More involvement of infectious dx pharmacist
seek more tools to guide my recommendations
better recommendations upon providers request
Cannot be implemented in my practice setting
Look at the hospital's antibiogram which was newly created
Better prepared to make appropriate recommendations
very informative
take into consideration use of nonformulary medications if appropriate for member's infection
improved knowledge
I am not directly involved in the decision making of antibiotic therapy.
I do not practice in direct patient care
watching for repeat therapy and underdosing
providers call
Consult ID more
Since it is difficult subject, a lot of factors involved, maybe gain some knowledge and understand
having understanding of the appropriate selection of the right antibiotic
cannot see this affecting my current job
speak to pharmacist
ID stewardship practices these recommendations at my site
in my area of practice, I do not treat or have direct patient contact. This lesson is a start to
becoming more knowledgeable about MDR therapies
more informed to discuss with my clinical RPh
Read more of the current literature and also know my antibiogram better
Pick up the phone more often to call prescribers who are choosing the wrong antibiotic
retail practice limited to consultation with clinicians and patients
I will assist Pharmacist in gathering information
Change in assisting pharmacists
increase my personal education further
discuss with others my need for more knowledge in the area when needed
administrative role vs clinical
formulary restriction
will make a change if needed
More willing to convey concerns about antibiotic selection
ensure appropriate therapy is prescribed
updated my knowledge regarding resistance
Better knowledge for working industry
I do not choose therapies better understanding on compounding
Speak with other clinicians
press for rapid diagnostic equipment
Insurance Formularies. No Change
I am not currently working with clinicians in proving consultation of infection diseases
I need more training ‐ still not confident
question providers about cultures and antibiograms
need to research more
inquire with colleagues/physicians more
will be more aware
As a tech ‐ maintain strict adherence to pharmacy protocol for MDR bacteria.
I am a cpht and will do what my RPH asks
15. Please indicate any barriers you perceive in implementing these changes. Other, please specify:
formulary
Physician education
I believe all of the above apply to our institution and in most of the institution in my country
(Nigeria) and we have a lot of barriers
finance
formulary
Clinical research work
clinical inertia from physicians (especially some older physicians)
Physician resistance
Formulary and availability of new labs tests
believe it or not, too many id docs that don’t accept these current strategies
IV compounding pharmacy practice
pharmacy tech not allowed
old physicians who are resistant to change
prescriber education
Endemic culture of antimicrobial overuse at my institution
formulary restrictions
back ordered drugs
done by clinical pharmacist
multiple barriers‐‐pt compliance, med staff compliance, institutional barriers, etc.
hospital formulary
lack of ID specialist
Physician specific
formulary restrictions
Lack of physician education on antibiotic stewardship initiatives
possible drug shortages
retail approval
our ID RPH left and we are in process of replacing our ID RPH
lack of being in this area on a regular basis
I CAN'T PRESCRIBE OR DIAGNOSE
formulary restrictions
physicians/other providers
formulary
Unfortunately with FTE constraints there is never enough time for antibiotic stewardship!
physician support
Lack of physician support
little or no input on antibiotic selection
Retail environment doesn't allow for intervention
time constraints
time constrain, inadequate staff
provider resistance
lack of multidisciplinary approach
Lack of Influence on providers
lack of physician openness
Formulary restrictions
Formularies
Strict formulary
lack of prescriber knowledge/buy in
Resistance from doctors to change in prescribing habits
Formulary/availability of medications
16. Will you attempt to address these barriers in order to implement changes in your competence, performance, and/or patients’ outcomes? If yes, how? If no, why not?
With our infectious disease pharmacist
We evaluate all of aminoglycosides daily and ABX therapy in ICU. When time permits more
resources are directed toward ABX .
Try to learn more
19. What topic areas would you like to see in future activities? Other, please specify.
All of the above and also polypharmacy in antimicrobial treatment, treatment of infection in
pediatrics
Use of antimicrobials in pediatrics
All of the above (5)
Good Manufacturing Practice
CERT PHARM TECH
provider call
Law
Antimicrobial use in elderly population
Disease diagnosis and treatment
Human side effects to pet flea prevention
Medical safety
CLL ‐NEW TREATMENTS
Treatment of multidrug resistant bacteria
Antibiotics and proper use. Gram negative vs. Gram positive out patient
Medication safety
Infection control on cancer pts
Poison Ivy
Infectious drug therapy after discharge
FreeCME (MDs, PAs, RNs, & NPs)
Did you perceive any bias or commercialism towards any product or drug in this activity? If yes, please
explain:
Pro‐new drug, basic options not covered
How many drugs are on the market fitting the limits of the discussion?
Ceftaroline
Supported by big pharma
7. Please elaborate how the activity impacted your knowledge, competence, performance and
patients outcomes in the treatment of multidrug resistant infection
better understanding
it help me change my practice
a lot to explain.. but certainly I’ve learned a lot
better understanding of new antibiotic choices
Use infection control techniques to reduce spread of infection
To better be able to elevate their issue and prescribe the appropriate treatment
increase diverse knowledge
ICU patients, VAP
I now have a broad idea of multidrug resistant infection
I am confident know how to treat multidrug resistant patients
They were very effective in educating us about MDR bacteria involving most of the problem
organisms we currently see.
Better understanding of mechanisms and medication
can apply to my work
Not currently treating these types of infections
Increased my awareness of variances between hospitals
recognize the mechanisms of resistance & use of appropriate empiric and sensitivity‐based
antibiotics
knowledge based on epidemiology of AB resistance has increased, allowing me to recommend
proper medications
I have more knowledge. I do not prescribe so it won't impact my patient outcome, but I will be a
more effective teacher and support for my patients and families
be more aware
Awareness of complications w/in‐hospital care and some updates on MDR organisms and tx
modalities.
Definite enhancement in bacterial mechanism of resistance and antibiotic choice.
Strategies given are great
New Knowledge
Always good to hear about coming antibiotics and review good practices in selection.
knowledge to deal with drug resistance
This knowledge is beneficial in healthcare documentation for recognition of errors and
discrepancies for flagging and risk management
very helpful
better and newer treatments to utilize
Increase education
Less treatment failures
I have learned about ceftolozone
short duration therapy for comm acquired infection
Effective shorter duration antibiotic therapy helps prevent/delay development of drug resistant
organisms
changed my thoughts the antimicrobials that I often use inappropriately
moderately improve patient outcome
in the practice
Good to hear the mechanisms of resistance ‐ binding site changes, destruction of antibiotics.
Would have helped if the Docs talked more slowly and /or had the antibiotics written out and
maybe a graph of what antibiotic to use with specific infection. I am a med surg nurse
Amazing info
less utilization
Remember cultures!
Improves knowledge and skills to improve outcomes in patients with multidrug‐resistant
infection.
minimize the wrong treatment with antibiotic
Better choice in therapy selection.
The faculty were obviously very knowledgeable, but there were too few slides summarizing
important information, and they spoke in a very "jargon‐y" way, which was difficult for someone
who does not spend much time in the hospital to follow. I learned a little about MDR infections,
but it could have been so much better.
coordination
Resistance and how microbes are changing
Exposed me to new information on antibiotic treatment.
Precisely and explained well
Discussion of the newer antibiotic combinations particularly was most helpful.
extensive education material for me learn about multidrug resistant infection
clearer view of some resistant pathogens
This has made me more aware of appropriate treatment regimens for specific pathogens and
also made me aware of new and upcoming drugs. Although I do not currently work in a setting
where I am prescribing antibiotics, I believe this will make me a better health care provider all
around.
To match antimicrobial to microbe
quinolone still valid 2nd choice
will think harder before ordering the stronger abx,
increased knowledge of changes in resistance treatment
It updates what I previously knew of the multidrug resistant infection and it has given me the
confidence to treat its occurrence when it happens
it was educational
This was well done and highly informative
improve medications
Patterns of multidrug resistance
Select appropriate antimicrobial therapy
Taking into consideration certain comorbidities
Better appreciation of antibiotic resistance and choice of medications and likely discussion with
Infectious Disease specialists when not certain what to use
gave me a framework for rational clinical decision making in choosing, dosing, and determining
length of treatment with antibiotics
New information
Although I am not a prescriber, my understanding of problem has increased. Work with
neutropenic pts and have a greater appreciation of the dosing patterns
good discussion of resistant strains
Better understanding of how happened and what to do
more cultures, less empiric therapy
more aware
The seminar has made good emphasis on adherence to treatment.
Good review. Very useful
more understanding
reaffirmed and made up to date my knowledge and competence to ensure optimal patient
outcomes
resistance
GOOD NEW KNOWLEGE
Newer treatment options and regimens.
Learned more about multi drug resistance
helpful
Really helped my understanding of resistance
I don't directly treat patients
Excellent. wish you had equivalent presentation for clinics vs hospitalized patients
use of new antibiotic
Mechanism of susceptibility
More information base in terms of treatment
The activity involves many drugs
How VRE causes resistance
This activity increased my knowledge
to be keen in choosing the antibiotic to be given
better understanding of newer and Older agents
As a holistic psychiatrist this will help with understanding what is happening to my patient and
to advocate for better hygiene and use of immune system bolsters
increased understanding of treatment
updated knowledge base
TREATMENT
VARIANCE IN SITUATIONS THAT ENHANCE
DRUG RESISTANCE
better understanding of this resistance progression
It added to it
Improved knowledge¨
I am not practicing presently
Gave me good information on some drugs I don't typically prescribe
more aware of handling MDR pathogens
I learned about VRE
better understanding on how to decrease spread of the bacteria’s
I was out of the loop regarding new therapies
info to prescribe
Better understanding Rx
Obtaining cultures
Utilizing hospital specific protocols
Spreading awareness
improved knowledge
Focus in output versus inpatient therapy
how to treat
LEARNED MORE about the behavior of resistant organism
Medication
concise summary of salient information
I do not treat in this military clinic‐we send out. But I will understand their treatment better
Expended spectrum of resistances and causes
I can spread the education of antibiotic resistance to friends, family, and patients
update knowledge
The activity helps me to be a better source for my students
This was informative. I learned new information, and some information I already knew were
reinforced
Learned the different approaches of doctors in tx of multi resistant bacteria
New update with resistance and new medication and combination txmts
Better understanding of resistant bacteria
better awareness
Awareness
gave me more insight into cef/tazobactam
Allowed me to understand how and why this is
more information gained will be translated into action for better results in patients
it let me know when to refer to specialist
Better educated in drug resistance
It was nice to see how they broke apart the case studies to better understand what was going
on
Change rx
Better knowledge regarding resistance
This activity increased my knowledge
Although I work in an outpatient setting, this will help me to identify patient who may need
admittance to the hospital. I will also perform more cultures as a result in order to maximize
efficacy and minimize resistance. I also did not know there is an Antibiogram option to evaluate
bacterial infections within our clinic, this is something that may be useful to me
Increased knowledge
Great overview
understanding application of abx therapy
more awareness
Don't do inept work anymore but increased my knowledge
This activity teach me on how to upgrade my knowledge about antibiotics and multidrug
resistant infection
after this session i gain a lot of knowledge and information which i can share it and use in our
patient
I do not write for abx tx.
Choosing antibiotic therapy more careful
gave me understanding od trend
Will discuss with colleagues
more readily able to choose appropriate abx
develop treatment plan
Better understand resistance
Be familiar with hospital/ outpatient and community microbii & related Antimicrobiome , use
narrow spectrum, effective antibiotic, check safety profile of treatments
12. I plan to make changes to my practice based on this activity, by incorporating the following
strategies. Other – please specify:
I have no direct patient interaction.
Continue what we are doing ‐ consulting
will be more knowledgeable consultant
Become more aware of the pathogens that are causing the greatest problem in my area
Actually I have been doing all that these doctors had been saying, but it was hard to get the
physicians to practice this type of good medicine. I really wish that every doctor would listen to
this presentation!
Assist the physician by ensuring that isolation precautions are being adhered to and that I am
verifying dosing and reporting any patient changes and critical labs in a timely manner
Patient education to best hygiene and wellness practice
I'm presently not practicing. I only practice out‐patient
more awareness of antibiotics
Always get a culture!
learn about which bugs most commonly effect my neonates
Unable to apply as I don't handle patient with such problems
Awareness
13. Please identify how you will change your practice as a result of participating in this activity.
Please identify how you will change your practice as a result of participating in this activity (select all that apply). Other – please specify:
working with physician to make sure we get sputum specimen on arrival and care for patient
Just keep doing what I have been doing
Review further NEJM article and IDSA guidelines
will attempt to find additional educational activities relating to infections control/epidemiology
Refer, but also more thoroughly discuss course with ID
refer to I.D. any resistant cases
use cultures more
have discussion with hospital residents to educate them as well
Increase awareness among staff and offer more knowledgeable consultation to other providers,
when sought
15. Please indicate any barriers you perceive in implementing these changes. Other, please specify:
Lack of physicians doing what they are supposed to
formulary
drug formularies
16. Will you attempt to address these barriers in order to implement changes in your competence, performance, and/or patients’ outcomes? If yes, how? If no, why not?
yes, by applying it to our healthcare setting
follow protocol
seek resources and support
Implemented changes
Encourage all my patients who are not covered by their employers to obtain insurance early
Work with ID
Will discuss with physician on a patient to patient basis.
improve communication and awareness of problem associated with bacterial resistance with
patient and hospital
improve care
appeal to insurance companies
documentation
Review new information
Continue to practice with best practices techniques. Time will be the teacher.
Judicious use of antibiotics
local, state, and federal levels
will follow guidelines
Study
in‐services
Out of my control
round with colleagues
monitor recurrences
Study the new antibiotics and recommendations
work with physicians who prescribe and treat patient
Proper patient education
give more information to patient
Education
conversation
Continue to educate myself regarding evolving practice standards
meetings
Consult more
talking with primary care provider
discuss it with patients
Work with infectious disease specialists
first off attempt to have the physicians listen to this presentation
Second make sure that every time we have an infection there is a culture!!!
Pharmacy consults and political intervention
future practice may change
education
doing more research
No patients
By having a team approach
more investigation
Co pay cards
Application of the information in this CME
Consult with my colleagues
Discussions with practice committees
It's pointless to fight administration
Communicate more w/ administration
By imparting health teachings to my client
Provide guidance to supervising physicians
in‐service meetings
talking
Complain to the drug reps
antibiogram
Moral hazard‐‐who cares how much money we spend, since "someone else" is paying? The #1
problem with healthcare today is moral hazard. It's everywhere.
More proactively deescalate antibiotics
Teaching other health professionals
Unsure, it's a big problem
Medicare doesn't cover anything I do
Have time to assess/counsel patients, consensus or professional guidelines and administrative
support
discussion with lab, increase education, prescribe less antibiotics in clinic unless warranted
education
ID consult
integrate patient education and intervention with time available
education
I will choose the right antibiotics sooner
PATIENT EDUCATION
BY KEEPING ABREAST OF INSTITUTIONALCHANGES AND BEING AN ACTIVE PARTICPANT
better educate colleges
Follow hospital protocols and consult w ID
I'm working on returning to practice in the near future on an out‐patient basis
By addressing my concerns with administration
patient education
Patient education
KEEP ORDERING CULTURES AND INVOLVE PHARMACISTS
Try to establish guidelines
education on pathogen
Utilizing resources, such as ID specialist and pharmacy for guidance when needed
Discussion with the Lab and Pharmacy
Reading
work hard at it
Discussion
discuss accessibility with administration
better education of the patient
Meetings
Protocols
Standards of care
Push harder for appropriate medication as medically necessary, based on newest evidence
counseling
use hospital antibiogram
Further study and education.
Better communication of rationale.
pursue further education
Education of partners in group
By educating junior staff
keep up on currents
better communication
by continuing to learn
difficult to bring about changes in small set up
it will involve looking at cultures ordered by multiple providers for trend analysis
share the information in the activity with our infectious disease doctor to help implement new
policy
refer to I.D. and get C and S if possible/
join committees
make sure that the patient really understands the importance and use the method of teach back
therapeutic options
Patient appeals
Education for patients
i will search and read more about this
Need managerial approval
information and use of appropriate abx
Discuss good compliance to patients.
advocating to the patients insurances
More vocal
work w/ pharmacy and infectious disease on creating cost effective recommendations
watch local resistance trends
These barriers involve 3rd parties that we have no control over. Patients can however be
counselled for improved adherence/compliance
yes coz this will help a lot in treating our patient
Through careful attention to detail
Educating the patient about the importance of complying with treatment protocols
educating
improve patient outcomes
Seek input from administration
It's a big problem in the hospitals
19. What topic areas would you like to see in future activities? Other, please specify.
Pharmacology
Anthrax
Cardiac surgery
New antibiotics.
Out patient & ER treatment protocols VS In‐Pt. hospital antibiotic use
Neonatal aspects
Arthritis
20. General comments:
thank you
Thanks
very nice activity
Good job
nice job
Thank you
Would like to see program about antibiotic resistance for sinusitis and std's
The doctors spoke quickly. It would have been helpful to have more charts
Excellent program
We need newer antibiotics to deal with drug resistance especially Urinary Tract Infection
very good
excellent
fewer acronyms and use the full name of drugs
Would have helped if the Docs talked more slowly and /or had the antibiotics written out and
maybe a graph of what antibiotic to use with specific infection. I am a med surg RN. I passed the
test on the second attempt.
Very good material
Great job.
very good CME activity
overall it was educational
True experts in their fields.
Extraordinarily interesting presentation
Thank you.
Excellent presentation
nice presentation
Great program, thank you
Job well done
GOOD NEW KNOWLEDGE
As an Alternative Health Practitioner
excellent CME
A VERY GOOD PROGRAM
I am a nurse not a prescribing professional. I will however use the knowledge gained.
Thanks for such useful info.
Excellent
Great discussion.
I feel that discussions are helpful but the inclusion of frequent visual materials summarizing
important concepts is very helpful. As this program relied much more on discussion than on
visual presentation I found it less effective for my learning.
very good
Very nice presentation with relevant information
very informative
Excellent
Wish there was an RN on the panel.
This activity is probably very worthwhile for individuals who already have expertise in the topic.
very good
Thank you for having program
Good talk, covered all aspects
Loved the interaction of both doctors. They were not "dry" to listen to.
Thank You
good review
Good presentation
Very knowledgeable speakers
all is clear thank you
thanks