Diane Jacobsen, MPH - IHI
Transcript of Diane Jacobsen, MPH - IHI
6/28/2011
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Session 2 – June 30th, 2011
Scott Flanders MD
Christopher Ohl MD
Edina Advic PharmD
Diane Jacobsen, MPH
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Our Expedition Director
Diane Jacobsen, MPH, CPHQ, Director,
Institute for Healthcare Improvement (IHI), is
content director for Project JOINTS, directs
the CDC/IHI Antibiotic Stewardship Initiatives,
Expeditions on Antibiotic Stewardship and
Sepsis, and serves as IHI content lead and
improvement advisor for the California
Healthcare-Associated Infection Prevention
Initiative (CHAIPI). Ms. Jacobsen also
directed Expeditions on Preventing CA-UTIs,
Reducing C. difficile Infections, Improving
Flow in Key Areas and Improving Stoke Care.
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Overall Program Aim
The Aim of this Expedition: To provide
hospitals with the most effective ideas and
practices in improving Antibiotic Stewardship
in their organization.
Objectives
Upon completion of this expedition, participants will be able to:
• Describe the impact of antibiotic overuse on complications, including
Clostridium difficile and adverse drug reactions, length of stay, costs,
and antimicrobial resistance
• Establish or enhance a multidisciplinary focus to heighten awareness
of the challenges of antimicrobial resistance and support antibiotic
stewardship
• Identify and begin improving at least one key process to optimize
antibiotic selection, dose, and duration of antimicrobial agents in their
hospital
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Expedition Focus
The expedition will focus on key “high leverage”
changes to ensure timely and appropriate antibiotic
utilization:
• Making antibiotics patient is receiving and start & stop
dates visible at point of care
• Reconciling and adjusting antibiotics – focused on care
transitions within the hospital
• Stopping or de-escalating therapy appropriately
• Monitoring and providing feedback on process measure to
assess progress over time
Agenda
• Welcome and introductions
• Follow-up from Session 1 –
- Review Assignment: what did you learn? – Diane Jacobsen MPH
- Review of questions – Chris Ohl MD, Scott Flanders MD, Edina Avdic
PharmD
• The role of Hospitalists – Scott Flanders MD
• “High Leverage Change” Making antibiotics patient is receiving and start
dates visible at point of care
• Testing on a small scale – designing a “test” in your hospital
• Final Questions & Close
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Medical Staff Leadership & Buy-in
Christopher Ohl, MD, is the Medical
Director for Antimicrobial Utilization
Stewardship and Epidemiology at
Wake Forest University Baptist
Medical Center, and Infectious
Diseases Associate Professor at Wake
Forest University School of Medicine
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Scott Alan Flanders, M.D.
Scott A. Flanders, MD, FACP, is a
hospitalist and clinical professor,
Department of Internal Medicine at
the University of Michigan Health
System. His clinical and research
interests include hospital medicine,
community-acquired and nosocomial
pneumonia, hospitalists, and patient
safety.
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Your focus since the June 16th Session
Operational and Team Issues
• Identify a unit-based multidisciplinary team to
actively test changes, identifying key roles in your
organization that may not currently be involved in
the process
• Getting Started
- what unit did you identify to begin your work?
- what roles will make up your unit-based
multidisciplinary team?
(nursing, pharmacy, ID, hospitalist, infection prevention,
others??)
- did you recruit additional roles/individuals not
previously involved in the process?
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Your focus since the June 16th Session
Operational and Team Issues
• Assess current process & Prioritize areas for
improvement/focus – what’s currently in
place in your hospital?
─ visibility of start & stop dates at the point of care
─ process for reconciling and adjusting antibiotics
at all care transitions
─ stopping or de-escalating antibiotics
─ monitoring & providing feedback on process
measures
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Follow-up from Session 1
Questions and Discussion
Why engage hospitalists?
• In the U.S., numbers of hospitalists are
growing
─ 30,000 in 2010
• Many hospitals have hospitalist programs
─2/3 of U.S. hospitals
• Increasingly taking the lead on QI work
─They understand systems redesign
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Hospitalists and Antimicrobial
Stewardship
• Antimicrobial resistance and antibiotic
complications (C.difficile) hit home
• Templates and checklists are
commonplace in hospital medicine
• Hospitalists must tackle issues with
signouts, handoffs, and care transitions ─ Dr X comfortable stopping the drug Dr Y started
• There often isn’t anyone else to do this?!
Hospitalists and Antimicrobial
Stewardship
Disease Specific Targets Ripe for Intervention
• Community Acquired Pneumonia
─ Is it really pneumonia?
─ How long should we treat it?
• Urinary Tract Infections
─ Overdiagnosis and overtreatment commonplace
─ Preventing CAUTI is a major national focus
─ Hospitalists are part of the solution
• Skin and Soft Tissue Infections
─ Guideline based strategies have been successful
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Today’s Focus
The expedition will focus on key “high leverage”
changes to ensure timely and appropriate antibiotic
utilization:
• Making antibiotics patient is receiving and start & stop
dates visible at point of care
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Making antibiotics patient is receiving and
start & stop dates visible at point of care
• Specific Change ideas:
1. Define a prominent location in the medical record and at the
bedside for antibiotic therapy to be documented (e.g., “this is day X
of Y”).
2. Develop a system to ensure that antibiotic days are counted
correctly (e.g., does the first day of therapy count as day zero or
day one?).
3. On admission, collect a complete list of the antibiotics a patient is
taking (i.e., what antibiotic the patient is on, at what dose, when it
was started).
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Making antibiotics patient is receiving and
start & stop dates visible at point of care
Specific Change idea:
1. Define a prominent location in the medical record and at the
bedside for antibiotic therapy to be documented (e.g., “this is day X
of Y”).
Things to consider:
-Can be within electronic medical record(EMR), computerized physician
order entry (CPOE) or paper based
-Group antibiotics together into their own section within the record
-Add the indication; “day 3 of Ceftriaxone for community acquired
pneumonia (CAP)”
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Making antibiotics patient is receiving and
start & stop dates visible at point of care
Specific Change idea:
2. Develop a system to ensure that antibiotic days are counted
correctly (e.g., does the first day of therapy count as day zero
or day one?).
Things to consider:
-specifically, determine how to handle antibiotics with multiple doses
per day.
-Scenario: A patient with a complicated case of cholecystitis is
admitted at 8 pm on Sunday and started on q.i.d. piperacillin /
tazobactam. The first dose is given at 10 pm with the next dose
scheduled for 6 am on Monday. Is Sunday or Monday day 1?
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Making antibiotics patient is receiving and
start & stop dates visible at point of care
Specific Change idea:
3. On admission, collect a complete list of the antibiotics a patient
is taking (i.e., what antibiotic the patient is on, at what dose,
when it was started).
Things to consider:
-Ideally, this should happen at every key transition
-In and out of the ICU, and at hospital discharge
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What We Expect of You
• “All Teach, All Learn” philosophy
• Join and participate on all calls
• Participate in the listserv discussion
• Test, test, test
• Share what you’ve learned (challenges as
well as successes and insights)
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What You Should Do Over the Next 14 Days
• Design a small test of change to ensure
─ visibility of start & stop dates at the point of care
• Ideas to consider………….
1. Define a prominent location in the medical record and
at the bedside for antibiotic therapy to be documented
(e.g., “this is day X of Y”).
2. Develop a system to ensure that antibiotic days are
counted correctly (e.g., does the first day of therapy
count as day zero or day one?).
3. On admission, collect a complete list of the antibiotics
a patient is taking (i.e., what antibiotic the patient is on,
at what dose, when it was started).
Upcoming Sessions 1-2pm ET
• July 14th – Reconciling and adjusting antibiotics –
focusing on care transitions
• July 28th – Stopping or de-escalating therapy
appropriately
• Aug 11th – Insights and challenges in community
hospitals
• Aug 25th – Brief report outs from participating hospitals:
progress and challenges
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