Antimicrobial Stewardship in LTC Roadmap to a Successful Start Jamie Moran, MSN, RN, CIC Quality Improvement Consultant Qualis Health

2 Qualis Health A leading national population health management organization The Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington The QIO Program One of the largest federal programs dedicated to improving health quality at the local level

3 Antimicrobial Stewardship The optimal, judicious use of antimicrobials Optimal: A condition most conducive to a favorable outcome Judicious: Using good judgement and sense Seeks to balance the need for best outcomes for recipients with the need to preserve therapeutic effectiveness for the population What is it?

4 JumpStart Stewardship Recognizes challenges in small hospitals Utilizes existing structures and relationships Focuses on small-scale interventions Moves organizations into action Can be adapted to long-term care

5 JumpStart Intervention Framework 1.Socio-political culture for optimal use of antimicrobials 2.Timely and appropriate initiation of therapy 3.Appropriate administration and de-escalation of therapy 4.Data, Transparency and Expertise (IHI-CDC, 2012) Primary Drivers of Stewardship

6 Roadmap

7 Assess Current State Demographics Size? Churn? (Admissions, Discharges, Transfers) Special Populations ? Microbiology Infectious Syndrome Profile Variation in Prescribing Antibiotic costs Systems for Stewardship (Core Elements) You are here

8 Identify Stakeholders Who will be affected by your stewardship program? Who are your KEY stakeholders? What’s in it for them? How do you create a win-win for your stakeholders?

9 Build Your Team Who is on your accountable team? Day-to-day management Expert consultation Communication with prescribers Education Oversight How does the AMS team fit in the organization? How are decisions approved? What does the team need to be effective?

10 Select an Intervention What one thing can you start doing? “Low hangers” Biggest need or impact Special focus area Overwhelmed? Think smaller! Use the Drivers Framework Change the culture Better selection and timing Better administration and de-escalation More transparency, communication, data Just do it !

11 Positive Clinical Impact Positive Financial Impact Political Expediency Resource Requirements Ease of Implementation 0 = None 5 = High 0 = None 5 = High 0 = Impossible 5 = Win/Win 0 = Impossible 5 = None 0 = Impossible 5 = Easy Prioritize Potential Interventions Winner !

12 Evaluate Data Sources and Metrics Select a key metric to report up and out Do the metrics reflect the intervention? Can you access the data reliably? Don’t forget “balancing” measures Don’t be a slave to data! How will you measure progress?

13 Plan Mitigation Strategies Useful analysis: SWOT Expect barriers! Consider up-front how you might handle obstructions and challenges How can you capitalize your strengths and opportunities to combat threats?

14 Create the Implementation Timeline Break down the process into 10 steps or less When can you start each step? How long will each step take? Who is responsible for each step? What data will you be tracking? What tangible products will be produced (milestones, deliverables, etc)? Soon is not a time

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16 MAKE THE BUSINE$$ CA$E No valid approach to calculating savings or cost avoidance OK to use educated guesses Effective stewardship programs save money in the first few years Include savings related to reduced infections Include soft targets like reputation in the community and recognized stewardship

17 Documents key facts about your AMS program Aim and business case summary Guiding principles and strategies Key activities and interventions of the program Team members and reporting structure Milestones Communication plan Metrics and measures of effectiveness Leader support (signature) Write Your Charter or Strategic Plan Put the pieces together

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19 Jump In! Start communicating with key stakeholders Invite participation by prescribers Educate the staff, residents, families Work the implementation plan Tweak as needed for success Evaluate the effectiveness at 1 year Add interventions, expand capacity, make your program more robust

20 JumpStart Have leadership commitment Have an accountable person or team Collect and report some data Educate your prescribers and staff Do one thing to standardize, optimize or reduce the use of one or more antibiotics Minimum Expectations of a Stewardship Program

21 JumpStart Stewardship Be enthusiastic, but realistic Aim big, but act small Choose something meaningful for your facility Overwhelmed? Go smaller! Lay the foundation for success

22 Q & A

23 For more information: This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. WA- C1-QH Contact Jamie Moran MSN, RN, CIC QI Consultant