1

Slide Title and Commentary Slide Number and Slide

Title SlideAcute Care: Onboarding Call # 1SAY: Host

Thank you for your interest in the AHRQ Safety Program for Improving Antibiotic Use. Johns Hopkins University and NORC, at The University of Chicago are excited to be partnering with the Agency for Healthcare Research and Quality on this very important program.

Slide 1

Presenter Sara CosgroveSAY:

I’m Sara Cosgrove and I am the speaker for today’s call. I’m a Professor of Medicine at Johns Hopkins University School of Medicine and I have a joint appointment in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health and I direct the hospital’s Department of Antimicrobial Stewardship.…On the screen is contact information for the project. If you have any questions or need to reach me after this webex, please use this information.

Slide 2

HousekeepingSAY: Host

Let’s take a quick minute to go over housekeeping rules for this call.

• Participant phone lines must be muted to avoid any distracting background noise.

• If you have a question, either ‘raise your hand’ in Webex or use the ‘chat’ feature to ask a question during the presentation. Both of these items are located within the Webex on the screen.

ASK:• If anyone has any questions about where to

Slide 3

AHRQ Safety Program for Improving Antibiotic Use

ACUTE CARE ONBOARDING CALL # 1

2

find or how to use these features, please unmute your phone now and ask...

SAY:• Generally, question and answer time will be

provided at the end of the presentation so if you have any questions, please make note of them and save them for the end. Please follow this structure unless I ask for any relevant questions during the presentation. In this case, please participate. Participation and active engagement is how you will get the most out of this presentation and out of this whole program.

Objectives of Onboarding Call # 1SAY:

Let’s get started. This is the first of two onboarding calls which provide an overview of this program. Today we have four main objectives to cover.

1. Understand the goals of the AHRQ Safety Program for Improving Antibiotic Use

2. Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program

3. Understand the timeline and components of the acute care educational toolkit

4. Learn the objectives and timeline for the AHRQ Safety Program

- We will start looking what this AHRQ Safety program encompasses. Slide 4

Goals of the ProgramSAY:

Let’s begin with the goals of this program.

Slide 5

3

AHRQ Safety Program for Improving Antibiotic UseSAY:

- The AHRQ Safety Program for Improving Antibiotic Use is an improvement collaborative that aims to improve antibiotic use across acute care, long-term care, and ambulatory care facilities throughout the United States.

- This module is targeting health care providers working in acute care facilities.

- The educational content that will be included in this program will integrate both clinical interventions and cultural interventions.

- This includes:1. evidence-based approaches to implement

antibiotic stewardship approaches and 2. interventions to increase the appropriate

use of antibiotics in acute care facilities for conditions patients are commonly hospitalized for and improving the safety culture within hospitals through adaptations of the comprehensive unit-based safety program or CUSP methodology.

Slide 6

Integrating Two Important ConceptsSAY:

-This program seeks to merge two very important concepts:

Antibiotic Stewardship and CUSP

-Antibiotic stewardship programs are designed to ensure that all patients requiring antibiotic therapy

Slide 7

4

receive the optimal antibiotics for their infectious conditions. -Traditional Antibiotic stewardship programs have focused on “technical” interventions and are often seen as “prescriptive.” -They often do not seek to understand and improve local culture around prescribing and do not engage some frontline providers, such as nurses. -CUSP is a method to improve safety in health care facilities by improving teamwork and communication among physicians, pharmacists, nurses, and other team members using the science of safety. -We will be integrating concepts of antibiotic stewardship and CUSP to ensure we are providing the best possible care for the patients we take care of.

Expected Outcomes of ProgramSAY:

Some of expected outcomes of this participation in this program include:

An improved safety culture in our hospitals Enhanced teamwork and communication

among health care providers A reduction in suboptimal antibiotic usage Improved antibiotic decision making A reduction in Clostridium difficile infections Improved health care provider, patient, and

family satisfaction Think for a minute about which of these

expected outcomes is most important to you? How will this program better your patients, your career, and your community? It’s important to realize how impactful this program is and will be for you.

Slide 8

Benefits to ParticipantsSAY:

We believe there are many benefits of participation in this program. Participating in this program provides you with

Technical assistance for implementing antibiotic stewardship programs and interventions.

Access to CUSP and Antibiotic Stewardship experts via bimonthly and monthly webinars in which successes and barriers to success are

Slide 9

5

shared and solutions discussed. Ability to network on the regional and national

level. Compliance with The Joint Commission

Antimicrobial Stewardship Standard. During the course of this program, participants

will have access to a comprehensive toolkit which will include tools and training to- Implement effective antibiotic stewardship

programs.- Assist them with optimizing their antibiotic

use.- Enhance communication between various

prescribers (e.g., nurses, nurse practitioners, physician assistants, physicians) of antibiotics as well as between patients and families

- Improve prescriber, patient, and family understanding of the potential harms associated with antibiotic use

ObjectivesSAY:

Objective 2- Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the Safety Program.

Slide 10

The Joint Commission Antimicrobial Stewardship StandardSAY:

- In January 2017, The Joint Commission Antimicrobial Stewardship Standard went into effect.

- Participation in the AHRQ Safety Program for Improving Antibiotic Use will improve compliance with this standard.

- There are 8 components in the standard.1. First, antimicrobial stewardship should be

Slide 11

6

established as an organizational priority.2. Second, staff and independent prescribers

should be educated on antibiotic use and antimicrobial stewardship.

3. Additionally, patients and families should be educated about antibiotic use.

4. Fourth, an antimicrobial stewardship program should be established and should include the following personnel (when available): infectious diseases physicians, pharmacists, infection preventionists, and practitioners.

5. Fifth, the stewardship program should include The United States Centers for Disease Control and Prevention’s Core Elements of Hospital Antibiotic Stewardship Programs, shown here and publically available online.

The Joint Commission Antimicrobial Stewardship StandardSAY:

6. Finally, the stewardship program should include organization-approved multidisciplinary protocols:

• Some examples of these include local guidelines for antibiotic use,

• re-evaluation of and feedback to providers regarding certain antibiotic prescriptions,

• implementation of an antibiotic time out by rounding teams and prescribers

7. The Joint Commission standard also requires that hospitals collect, analyze, and report data on its ASP’s progress.8. And finally that the hospital takes action on improvement opportunities identified by its ASP.

ASK:Does anyone have any questions about the Joint Commission Antibiotic Stewardship standards that we are adhering to or why any of these 8 components are required?

Slide 12

ObjectivesSAY:

Objective 3- Understand the timeline and components of the acute care educational toolkit

Slide 13

7

Educational ToolkitSAY:

In this program you will be provided with everything you need to be successful. This includes an educational toolkit and the schedule for content and coaching calls.

- The educational toolkit consists of a series of technical and adaptive eLearning modules. These modules should be viewed independently and then will be reviewed as a group via webinars. The webinars will be held 1-2 times per month. Not only will you hear more about the content, but you will be able to ask questions, hear from the experts in the field and share stories with other participants. It is important that you not only view the short eLearning, video based modules but that you also join the webinars so that you are able to apply the steps that you learn to your practice.

Slide 14

Participant OverviewSAY:

In additional to webinars there will be a variety of other material developed targeting providers and families:- For facilities with existing antibiotic stewardship programs, there will be 3 levels of participants.

1. The first is the Antibiotic Stewardship team, which generally consists of a physician and pharmacist, although there may be other members.

2. Next are the unit champions for this program. Examples of this include a medical director, a clinical pharmacist, a nurse manager or educator. It is preferred that there is a

Slide 15

8

physician, pharmacist, and nurse champion for each participating unit.

3. The third group of participants are frontline staff. While we encourage the participation of all frontline staff on calls, we realize this may not be feasible. Consequently, all educational content will be available on the program’s website and frontline staff who were unable to participate on calls or would like a “refresher” of certain topics will be able to access this content at any time.

-For facilities without existing AS programs, the institution should identify physician and pharmacist leadership to form the backbone of the stewardship team.-These individuals will be trained in how to effectively develop and operate an antibiotic stewardship program during the course of the AHRQ Safety Program.

ObjectivesSAY:

The last objective for this call is to learn about the timeline for the AHRQ Safety Program and to hear about what objectives will be covered over the next many months. This will give you an overview for what to expect to learn throughout the modules and webinars and will list who is expected to participate.

Slide 16

Onboarding Call # 2SAY:

The next call you have will be the Onboarding Call number 2, which will occur later this month.

The target audience for this call is the antibiotic stewardship team.

The goals of this call are too Apply the Four Moments of Antibiotic

Decision-Makingo Understand how the CUSP approach can

improve safety cultureo Understand how to use the “Team

Antibiotic Review Form” to review antibiotic use with frontline staff

Slide 17

9

o Understand how to access data and upload data on the AHRQ Safety Program website

Antibiotic Stewardship Program (ASP) DevelopmentSAY:

- In May 2017, we will review a module entitled “Antibiotic Stewardship Program Development”

- This module is targeting the antibiotic stewardship team.

- The objectives of this module are to1. Understand the key personnel that are

involved in developing an ASP2. Understand how to work with a senior

executive to further the goals of the ASP3. Describe and discuss the pros and cons of

common ASP interventions4. Discuss the evaluation metrics for ASPs5. And, understand the steps involved in

establishing an ASP

Slide 18

Improving Antibiotic Use is a Patient Safety Issue (CUSP 1)SAY:

The first module that targets members of the ASP, unit champions, and frontline staff is entitled “Improving Antibiotic Use is a Patient Safety Issue”

- The objectives of this module are to1. Discuss the potential harm associated with

antibiotic use2. Understand that patient harm is largely

preventable3. Understand that change efforts within an

institutions often require a focus on systems, and not just individuals

4. Recognize the principals involved in safe design

5. And finally, to understand the importance of diverse input to prevent harm

Slide 19

Behavior Change Theory for Antibiotic Stewardship LeadersSAY:

In June, we will be discussing a module targeting

Slide 20

10

antibiotic stewardship leaders entitled “Behavior Change Theory for Antibiotic Stewardship Leaders”The objectives of this module include to

1. Understand what motivates health care providers to prescribe antibiotics

2. Understand basic theories regarding implementation science and organizational change to implement antibiotic stewardship interventions and to change antibiotic prescribing habits

3. And finally, to understand successful antibiotic stewardship behavior interventions in the acute care setting

Identifying Targets for Improving Antibiotic Use (CUSP 2)SAY:

- The second CUSP discussion will occur in June and participation from the antibiotic stewardship team, unit champions, and frontline staff is encouraged

- During all CUSP modules, there will be examples specific to antibiotic stewardship embedded in the discussions

- During the course of this discussion, participants will be able to1. Understand how to identify patient safety risks

in their clinical areas2. Understand how to be proactive in asking staff

how the next patient will likely be harmed3. Understand how to leverage frontline wisdom

to guide safety improvement efforts

Slide 21

Improving Antibiotic Use by Learning from Defects (CUSP 3)SAY:

- The third CUSP discussion will occur in July- By the end of this discussion, participants will be

able to1. Understand how to identify the relevant system

factors related to defects in a system2. Develop interventions to reduce future risk 3. Ensure that interventions are effectively

addressing defects related to antibiotic prescribing

Slide 22

11

Improving Teamwork and Communication Around Antibiotic Prescribing (CUSP 4)SAY:

- Also in July 2017, we will discuss “Improving Teamwork and Communication Around Antibiotic Prescribing”

- By the end of this discussion, participants will be able to1. Understand the importance of seeking

input from all team members when making antibiotic prescribing decisions

2. Understand how to use available AHRQ Safety Tools to improve communication related to The Four Moments of Antibiotic Decision Making

3. And, understand how to effectively communicate potential harm antibiotics can cause with patients and other healthcare providers

Slide 23

The Team Approach to Stewardship of Asymptomatic Bacteriuria and Urinary Tract InfectionsSAY:

- The next several discussions will focus on specific infectious diseases conditions commonly encountered in the inpatient setting.

- The first is entitled “The Team Approach to Stewardship of Asymptomatic Bacteriuria and Urinary Tract Infections”

- The objectives of this discussion are to:1. Understand how to distinguish

asymptomatic bacteriuria, cystitis, and pyelonephritis

2. Develop empiric treatment recommendations for UTIs that are institution specific and minimize adverse events

3. Discuss opportunities for de-escalation of antibiotic therapy for UTIs after additional clinical data are available

4. Discuss reasonable durations of antibiotic therapy for UTIs

5. Discuss challenges and ambiguities in developing and executing a standardized approach to the management of

Slide 24

12

asymptomatic bacteriuria and urinary tract infections

Additional Syndrome-Specific ModulesSAY:The other syndrome-specific modules that will be addressed include:

- -Community-acquired lower respiratory tract conditions in September 2017

- -Healthcare-associated pneumonia and ventilator-associated pneumonia in October 2017

- -Skin and soft tissue infection in November 2017

- -Intra-abdominal infections in December 2017And, Clostridium difficile infections in January 2018

Slide 25

Coaching Call About Team-Based Stewardship ImplementationSAY:

-In February 2018, we will lead a coaching call to discuss team-based antibiotic stewardship implementation-During this call, we will discuss barriers to and potential mitigation strategies for implementation of team-based stewardship interventions- This will be an interactive discussion between all participants on the call

Slide 26

Sustaining Antibiotic Stewardship EffortsSAY:

-And finally, in March 2017, we will have a webinar discussing “Sustaining Antibiotic Stewardship Efforts”-By the end of this discussion, participants will be able to:

1. -Understand the need for stewardship interventions to be sustained and have a continued effect

2. -Discuss approaches for identifying new stewardship targets

3. -And, discuss personnel and resources necessary for a stewardship program to successfully be sustained

Slide 27

Additional Educational Material Slide 28

13

SAY:

In addition to the series of webinars, there will be additional educational material available to participantsThese include

A pamphlet for patients and families that describes why antibiotics are not risk neutral and the reasons they should be prescribed judiciously

A commitment poster that can be adapted by participating sites (for example- inclusion of the institution’s logo) that informs patients that the institution is committed to prescribing antibiotics only when necessary as they want to avoid unnecessary harm caused by antibiotics whenever possible

An antibiotic time-out tool that can be used by teams when they are rounding to review using The Four Moments of Antibiotic Decision-Making to ensure patients’ antibiotic regimens are being optimized

A Team Antibiotic Review Form to be used by antibiotic stewardship program members when reviewing antibiotic decision-making with frontline staff

Any finally, a series of fast fact sheets that will address important points regarding a number of antibiotic stewardship topics. These sheets can be adapted as necessary for use during discussion among teams and can be used to develop local antibiotic treatment guidelines

Benefit SummarySAY:

There are a number of benefits associated with participating in the AHRQ Safety Program for Improving Antibiotic Use. These include

-Education for ASPs and frontline providers in approaches to improving antibiotic use

-Assistance with addressing the behavior and cultural drivers of antibiotic prescribing

-Approaches to improving 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

Slide 29

14

QuestionsASK:

At this point, does anyone have any questions about the program or any of the content that was just presented? Please type your question into the question or ‘chat’ features in WebEx so that I can address it.

Slide 30

Next StepsSAY:

This concludes the first of two onboarding calls that you will have. Your next WebEx will take you further in your onboarding knowledge. - Contact us at antibioticsafety@jhmi.edu between now and your next call if you have any questions or concerns.

Slide 31

15