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The Steward-Ship Laveer

AMS Laveer 690 px


Welcome aboard our AMS Stewardship newsletter

September 2018

Fall is here – we hope that you are experiencing a successful antimicrobial stewardship voyage!  We continue 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 look forward to working with you on reaching your goals.

All Hands – Information for All about the Initiative

Here are the updates we have for you!

Data Reports 4 – Your secure-file transfer folders have been updated with your fourth Qualis Health report on antibiotic usage among Medicare Beneficiaries, by your Tax Identification Number (TIN).  These reports include data from 2017 Q2 through 2018 Q1.

Please note that many organizations will see a significantly higher value for potentially inappropriate antibiotic prescriptions for upper respiratory infections in this newest, upcoming 2017 Q2 to 2108 Q1 report.  We have updated the National Drug Codes (NDC) for our WSCWTF antibiotic list. There were several antibiotic NDC codes that were inadvertently excluded from our previous URI prescribing data.  Our upcoming report includes the same content and the same analytic methods as the previous reports, but is being run with the updated antibiotic list.  We have added a figure with historic data for comparison (with consistent NDC code lists) and to provide you data trends over time.   We apologize for this discrepancy and for any misunderstanding that this error has generated.  

AMS Activities Assessment  – AMS Activities Assessment  – We will update CMS on your collective progress toward implementing the four core elements in October, so we’re giving you another opportunity to inform us on how your AMS processes are moving ahead with this  assessment.  https://www.surveymonkey.com/r/YKQR76Z

  • If you completed previous assessments, PDFs of your responses have been uploaded to your secure-file transfer folder (file name is [Your TIN]_ [State]_Assessment_.PDF).
  • Please contact Suzie Potter at susanp@qualishealth.org for questions on SFTP access for reports.

Office Hours Update – Thank you to those who attended our Office Hours in June through August.  During these Office Hours we are providing some “what’s new” information as well as a forum for peer to peer sharing.  

We are cancelling Office Hours for October.  Our next Office Hours will be held on November 8, 2018. Register here. 

Through the Porthole – Your Monthly Resource

Buoy your AMS program!

Overview of Core Elements and References for Action Implementation

For a recent overview of the current state of antimicrobial stewardship in outpatient settings, review this article by Zetts, et. al. titled “Outpatient Antibiotic Use and the Need for Increased Antibiotic Stewardship Efforts”.  This article provides excellent references and evidence basis for many of the core element recommendations.  Though it is written in a pediatrics journal, the messaging is relevant to all outpatient settings.  

New Resources -

  • The MITIGATE toolkit for Emergency Departments and Urgent Care settings was written by several AMS experts and supported by the Center for Disease Control.  Though it has a focus on Emergency and Urgent Care settings, much of the information is generalizable to other ambulatory settings.  This guide uses the 4 core elements as a structure for program implementation.  Some highlights of the document include 1) a list of all ICD 10 codes for infections may be useful to report development or identification of visits for audit (pp 18-22) and 2) Interview and survey questions to assess the current provider knowledge level and attitudes toward antibiotic prescribing (pp 30-42).  These questions can be good tools to help you identify topics for education and also to evaluate your staff’s attitude toward AMS. 

**TIP** Understanding the attitudes and knowledge of your staff can help you to identify appropriate education material or different approaches for getting buy-in for your stewardship program.  Learn from your staff responses to these interview and survey questions and prevent your Antimicrobial Stewardship Program from running aground!

  • The National Coordinating Council (NCC) has compiled the learnings and tools developed or vetted by Quality Innovation Network/Quality Improvement Organizations (QIN/QIOs) nationally.  The resulting Field Guide is structured around the 4 core elements and provides additional resources for each element.  Look up the sample policies and additional tracking tools for upper respiratory infections (p 16).

Clinician Education

For additional opportunities for nursing and physician continuing education (CNE and CME), please view the new materials on the Center for Disease Control and Prevention CDC Train on Antibiotic Stewardship.  There are several new Modules including outpatient topics.  There are also setting-specific modules (dentistry, long term care and emergency departments).

Here are the newly released Section 2 training topics that are relevant to outpatient settings:

  • Background and errors in outpatient antibiotic use in the U.S.
  • Inappropriate antibiotic use and opportunities for improvement
  • Core Elements of Outpatient Antibiotic Stewardship
  • Communication training for clinicians to improve outpatient antibiotic prescribing and use

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”.

On August 29, 2018 the National Coordinating Center (NCC) hosted the presentation "Reducing Inappropriate Antibiotic Prescribing in Outpatient Settings Using Behavioral Interventions". This presentation focuses on behavioral interventions for providers to reduce unnecessary antibiotic prescribing, while maintaining patient satisfaction with care.  The following nationally recognized speakers provided excellent presentations:

  • Katherine Fleming-Dutra, MD, Center for Disease Control and Prevention provides an overview and data update
  • Daniella Meeker, PhD, Keck School of Medicine, University of Southern California discusses her publications on “nudging” providers through public commitment and providing specific feedback.  
  • Larissa May, MSPH, MSHS, University of California-Davis describes specifics of antimicrobial stewardship in emergency departments and urgent care settings and reviews the research that resulted in the MITIGATE toolkit.

**TIP**Use this presentation at staff meetings to provide information on antimicrobial stewardship interventions that really work.   This can be a component of your staff educational program and can help to satisfy the “Education and Expertise” core element of “Clinician Antibiotic Stewardship Education”.

Patient Education

  • View this 8 minute video that was recently released by the National Coordinating Center.  Dive into this question and answer-based educational video. It can be downloaded and played in a waiting area or at venues such as health fairs, immunization clinics or employee trainings.  The video can be downloaded with or without music. (This is an MP4 file and may not be compatible with your PC or MAC.)
  • Here is a fun tool for helping to educate patients on antimicrobial stewardship.  Provide this to patients while they are in your waiting room or as an activity on your website.  It is a word search with AMS and infection prevention-related terms (with definitions) to help increase awareness and messaging on antimicrobial stewardship.  

**TIP** Educating patients on general topics related to antibiotic resistance and infection prevention will help them to understand your antimicrobial stewardship efforts.   Distributing or directing patients to this information antibiotic resistance and reducing infections satisfies the “Education and Expertise” core element of “Educate about the potential harms of antibiotic treatment”.

Welcome to Paula Parsons

Welcome to Paula Parsons, your new Washington Quality Improvement Associate in Washington State. Jason Lempp, your stewardship anchor in Washington state, is no longer working at Qualis Health.  We wish him a bon voyage as he embarks on his new endeavour.  Martha and Paula remain on deck at Qualis Health to help you on your AMS journey.  Don’t hesitate to give us an “ahoy”.

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