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The Steward-Ship Laveer

AMS Laveer 690 px

 

Welcome aboard our AMS Stewardship newsletter

June 2018

Summer is nearly here – we hope that your antimicrobial stewardship voyage is successful!  We’re continuing to support your efforts in meeting, maintaining and exceeding at least one activity in each of the CDC’s Core Elements of AMS in Outpatient Settings. We have over six more months of working with you on reaching your AMS goals.

All Hands – Information for All about the Initiative

Here are the updates we have for you this month!

Data Reports 3 – Your secure-file transfer folders have been updated with your third Qualis Health report on antibiotic usage among Medicare Beneficiaries, by your Tax Identification Number (TIN).  These reports include data from 2017 Q1 through 2017 Q4.  For those who submitted your provider’s NPI numbers by location to us, you will see those reports as well.

AMS Activities Assessment 4 - We need to update CMS on your collective progress toward implementing the four core elements in July, so we’re giving you another opportunity to let us know how your AMS processes are moving ahead with this fourth assessment (but fifth survey after the initial “baseline” from August 2017).  https://www.surveymonkey.com/r/6PZS3KM

  • If you completed previous assessments, PDF(s) of your responses  have been uploaded to your secure-file transfer folder (file name is [Your TIN]_[State]_Assessment_.PDF).

Consider the following

  • Did you receive and display an attestation poster from Qualis Health?  If so, please attest to the “displaying public commitment” core element under “Leadership”.
  • Did you receive your data reports and share this with your AMS committee and providers?  Consider whether receiving and sharing this data satisfies the “Tracking and Reporting” core element for your organization.
     

Office Hours Update: Thank you to those who attended the 04/12/18 and 05/10/18 Office Hours.  During the April Office Hour we demonstrated the function of a newly developed chart audit tool designed to evaluate your prescribing practices.  The example tool shows the view of how graphs will auto-populate after audits are entered.  The audit tool can be downloaded for you to enter your own data, track your progress and view results by provider.  All these tools and more are still available on our Selected Resources page.

In May, we reviewed the newly released Journal of the American Medical Association letter on “Antibiotic Therapy Duration in US Adults with Sinusitis”.  This study reviews over 3 million prescriptions for sinusitis and summarizes the antibiotics prescribed and the prescription  duration.  The majority of antibiotics were prescribed for too long and/or with an inappropriate antibiotic choice.  This prompted discussion on the challenges of auditing for sinusitis prescribing.

Don’t forget we have another office hours scheduled for June 14th. Register here.

Through the Porthole – Your Monthly Resource

Hop on board with these additional resources!

Action

One way to improve antibiotic prescribing is to identify which patients with self-reported penicillin allergies have true penicillin allergies and which patients are able to tolerate penicillin treatment.  According to the   “Evaluation and Management of Penicillin Allergy” (Pongdee, et. al., 2018, Mayo Clinic Proceedings), 80-90% of patients with self-reported penicillin allergy are able to take penicillin.  If penicillin is a first-line antibiotic recommendation, a documented self-reported allergy can result in unnecessary increases in treatment cost and the use of broad spectrum antibiotics.  This Mayo Clinic article recommends an expanded list of clinical history questions to identify the likelihood of true allergy.  Reading this article also offers free CME credits (click the “Concise Reviews” tab and find this article and exam for 1 credit).

Essential Clinical History Questions

Get CME credit by taking a short exam after reading the article.

Mayo Clinic Proceedings

Additional information on evaluation of penicillin allergy can be found in the CDC fact sheet.

You may consider implementing penicillin skin testing as part of your penicillin allergy evaluation.  Penicillin Skin Testing:  Potential Implications for Antimicrobial Stewardship (Unger, Nathan, et. al, 2013, Pharmacotherapy) and Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network (Trubiano, et. al., 2016, Open Forum Infectious Disease) are excellent resources on this topic.  Here is a recent publication on the cost of penicillin testing. 

**TIP** Consistent use of a clinical history questionnaire for penicillin allergy will help prescribers identify patients with true penicillin allergies.  This will allow them to prescribe the narrowest spectrum antibiotic possible for patients.  Implementing this activity in your clinic would satisfy the “Action” core element of “Use evidence-based diagnostic criteria and treatment recommendations”.

Clinician Education

For additional opportunities for nursing and physician continuing education (CNE and CME), please view the CDC series on Antibiotic Stewardship: Section 1.  There are 3 modules, each approximately 45-60 minutes in length.  The continuing education credits expire in February, 2020.

These are the goals of the education

  • Describe the urgency and gravity of antibiotic resistance as a threat to both patient safety and public health.
  • List the benefits of antibiotic stewardship across the healthcare spectrum.
  • Describe the epidemiology of adverse events linked to antibiotic use and their typical patterns of clinical presentation.
  • Apply appropriate antibiotic management methods to improve the quality of pharmaceutical care.
     

The target audience is:  Physicians, Physician Assistants, Pharmacists, Advanced Practice Nurses, Registered Nurses, Licensed Practical/Vocational Nurses, Certified Health Educators

Note, additional trainings are available on this CDC site for CE credit to:

**TIP** Providing antibiotic stewardship education to prescribers, nurses and office staff is a key component of your program.  This series provides basic education on stewardship with the ability to obtain CE credit for nurses and physicians.  Implementing this activity will satisfy the “Education and Expertise” core element of “Clinician Antibiotic Stewardship Education”.

Patient Education

Do you provide patients education on the potential side effects of antibiotic use?  This infographic from the CDC shows the possible side effects a patient could experience when taking antibiotics.  This type of education can help patients understand the risks of antibiotic use and quickly identify and understand side effects.
 

Antibiotic Side Effects

**TIP** Educating patients on the side effects of antibiotics will help them understand that there are risks to taking these medications.  Distributing or directing patients to this information on the possible side effects of antibiotics satisfies the “Education and Expertise” core element of “Educate about the potential harms of antibiotic treatment”.
 

As a reminder, past issues of the Laveer can now be found through the “Initiative Information” section at the bottom of our Resources Page.

As always, your stalwart stewardship-mates Martha and Jason are here to help you on your AMS journey.  Don’t hesitate to give us an “ahoy”.