August 17, 2017

The Core of Outpatient Antibiotic Stewardship

Objectives

• Discuss the CDC’s Core Elements of

Outpatient Antibiotic Stewardship,

• Identify at least one method, for each Core

Element, that can be implemented in your

office practice toward antibiotic stewardship,

• Understand how to develop measures to

track success.

Healthcare-Acquired Infections

MDRO C-Difficile

Imagine

Dirty Wounds:

Immunosuppression

Prophylaxis

Prophylaxis

"The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism."

Alexander Fleming; Nobel Prize 1945

Antibiotic Stewardship

CDC Core Elements of Outpatient Antibiotic Stewardship

• Commitment

• Action for Policy & Practice

• Tracking & Reporting

• Education & Expertise

Commitment

Commitment

• Public displays

– Posters

– Social Media Messages

– Press release materials

– Incorporation into Board and Medical staff meetings

– Web-site banners

https://www.cdc.gov/getsmart/community/materials-references/index.html

• Single Team Leader

– Awareness

– Manager of the implementation

– Watches the data

– Accountable to Sr. Leaders

• Job Descriptions

– Set forth as an expectation of the job

• Evaluations

– Measure specific

expectations

• Communicate with staff

Clinician Checklist

Take Action!

Take Action!

Take Action!

• Communication Skills Training

– Education – Scripting

• Justification documentation

• Clinical Decision support

• Call centers/web communications

– Reduce unnecessary visits, re: colds

Examples of things to measure

• Per physician and

overall

• MACRA measures

Examples of overall measures

% times an antibiotic is prescribed without a

clear indication specified.

% times watchful waiting was implemented

when a patient presents with URI symptoms.

Examples of per physician measures

% times Dr. Z documented a justification for

antibiotic prescription

% times Dr. X used watchful waiting when a

patient presented with URI symptoms.

MACRA measures

• Adult sinusitis

• Children with URI

• Treatment of MSSA

• Acute bronchitis

• Perioperative care: Prophylactic antibiotic

• Total knee replacement

Healthcare Professional Education

Patient Education

• Some infections might improve without antibx

• Serious potential harm

– Allergic reactions,

– C. Diff,

– N/V, diarrhea

– Links to other illness when used in small children

Teach Back

https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool5.html

Stacie Jenkins, RN, MSN Sr. Director of Quality & Patient Safety

318-227-7206 staciejenkins@lhatrustfunds.com

Questions?