ASP CORE ELEMENTSBUDDY NEWTON, MD

CDC CORE ELEMENTS OF AN ASP

1. Leadership Commitment

2. Accountability

3. Drug Expertise

4. Action

5. Tracking

6. Reporting

7. Education

LEADERSHIP COMMITMENT/ACCOUNTABILITY

• C-suite to can issue a board-approved statement supporting ASP and set up periodic information sessions of ASP activities and outcomes to the hospital board

• Establish an ASP Committee with a charter which identifies specific responsibilities of the committee and members• Should be MULTIDISCIPLINARY (physicians, pharmacy, lab, admin, nursing, infection prevention, IT)

• Designate a physician (with dedicated ASP time and training) who is responsible for ASP outcomes and can provide feedback to both C-suite and providers

• Integrate current QI/Safety activities into the ASP (“don’t reinvent the wheel”)

• Issue a commitment statement from key hospital leaders to hospital employees

DRUG EXPERTISE

• Hospital or outside support for ASP training programs (SIDP, MAD-ID)

• Dedicated ASP time with appropriate training

• IV-to-po programs

• Automatic renal dosing

• Pharmacokinetic dosing of AGs and vancomycin

• Provide individual chart review and provider feedback based on evidence-based national practice guidelines

• Develop & monitor restricted ABX formulary

ACTION• Develop or modify CAP, UTI, CDI, +/or SSTI order sets. IDSA guidelines readily

available and easy to set up

• Require dose, duration, and indication for all ABX orders

• Identify your most used ABX and see if evidence-based guidelines support early de-escalation or in some cases, discontinuation

• Pharmacy review of duplicate coverage and pharm initiatives

• RN protocols for automatic C diff isolation and diagnosis

• RN ABX 48-hour “time-outs” reported to providers

ACTION (OTHER EXAMPLES)• Develop a PPI use reduction protocol

• Develop or update an antibiogram

• Beta-lactam allergy reduction (questionnaire, PCN challenge program, PCN skin testing)

• S aureus bacteremia treatment protocol

• Vancomycin use reduction (MRSA nasal screening in PNA, AUIC dosing, PCN allergy reduction)

• Lab “stewardship” to improve testing efficiency and appropriateness

• Compliance with sepsis order sets, CMS core measure compliance, sepsis mortality rates

TRACKING• Develop and maintain an antibiogram

• Monitor ASP recommendation compliance rates and compare LOS or LOT for compliers vs noncompliers

• Monitor C diff rates and other HAIs (probably already do this via Inf Control)

• Monitor overall or specific ABX administration rates (DOT, DDD, ABX usage/pt days)

• ABX rates compared to MDRO rates (e.g.- vanco use compared to MRSA rates, carbapenem use compared to ESBL rates, etc)

• Track adherence to facility-specific order sets for CAP, UTIs, CDI, SSTIs or policy adherence with dose, duration, and indication

• Monitor ABX overuse during transitions of care (esp at discharge)

• Report ABX use data to NHSN (requires compatible software)

REPORTING• Report results of what you are tracking back to the C-suite, hospital board, key hospital

committees, medical staff, and hospital staff. Keep it very transparent!

• Physician champion or CMO can review provider-specific reports with individuals clinicians (esp the “problem children”)

• Publish annual antibiograms for all staff

• If possible, join a collaborative for benchmarking and self-assessment (you’ve already done this by being here today!)

• Presentation at periodic staff meetings or Annual Medical Staff meeting

• Newsletters, emails, posters

EDUCATION• Collaborative webinars, newsletters, blogs, etc.

• ASP education at annual Medical Staff meetings and periodic department meetings

• Passive education with reportable items on posters, infoTVs, etc.

• Incorporate ASP education and awareness into new provider and staff orientation and any necessary annual training• Document education with a quiz to complete the session

• Patient/family education with specific patient stories, ABX education material, C diff and HAIs

SUMMARY

• Compliance with the CDC Core Elements is essential to a successful ASP and compliance with regulatory agency requirements

• Find action items that you already do or things that need to be done in order to help streamline and standardize your common medical problems. These can then be tracked and reported and thus lead to education.

• DON’T MAKE IT HARDER THAN IT HAS TO BE!!