Clinical Commentary: Multidrug Resistant Bacteria – An Ongoing … · 2017-10-04 · •...

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


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


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


Post n=3,809


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


Post n=1,206

18%32% 38%

12%3%

10%

85%

2%0%

25%

50%

75%

100%

A B C D


Post n=3,809


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


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


Post n=1,206


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


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




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




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


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


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


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


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

Clinical Commentary: Multidrug Resistant Bacteria – An Ongoing … · 2017-10-04 · •...

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