2109 Antibiotic Stewardship Programs with Limited Resources Nikki Ripplinger, RN, IP, CIC, Employee Health Thursday, June 13 no financial disclosures

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 Objectives Assess your facility’s current state Define where you should begin State the obstacles you face at your facility Define the resources you have Research who can help you Explore where you can find funding

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 Where Do We Start? Northwest Antimicrobial Stewardship Summit At our critical-access-rural hospital, we knew we needed to develop an ASP. We had been completing informal reviews of our patient’s antibiotic use, our nursing staff was informally watching how long a patient had been on an antibiotic, our lab department manger sent out a quarterly anti-biogram, but there was no formal plan and no reporting anywhere. In April of 2016, I received an email about a conference offering titled Northwest Antimicrobial Stewardship Summit, from my state HAI director. There were scholarships available for travel expenses and the cost of the conference was around $50!  We sent our Pharmacist. This is what she returned with, and where we started:

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 A Jump Start Stewardship guideline for Implementing Antimicrobial Stewardship in a Small, Rural Hospital

Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 Identify Key Stakeholders Pharmacist, Brad CNO, Angela IP, Nikki TVH Pharmacist sits on the IP Team, is on the ASP Board Is recruited for Head of ASP TVH Chief Nursing Officer oversees Infection Prevention and Control Efforts, as well as Pharmacy TVH Infection Preventionist leads the IP Team; Other Team members are Clinic Manager, Doctor, EVS, Surgery Manager, Lab Manager, Maintenance Manager, Medical Imaging Manager, Infectious Disease Telehealth

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 MAR – Medication Administration Record Build your team and resources: What resources can we find? Who can help us? New EMR, difficult to extract necessary data to submit to NHSN ** Found a Web-based “Cloud” company that provides low price per patient bed interface between EMR and NHSN Our Pharmacist learned to design and pull reports to place into Cloud interface

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 Admissions and Discharges Location Transfers Painful Process for Pharmacist – Reports he designed and pulled data from EMR

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 This Cloud-Based Program we found takes the Antibiotic Data our Pharmacist enters, and puts it in a format that can be entered into NHSN Pharmacist uploads his reports into Cloud

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 Cloud-Based Interface NHSN Unvalidated Validate Carefully look it over, go through all 3 tabs, if it looks reasonable and accurate Submit Download Now switch to the NHSN website

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 Surgical Antibiotic Improvement Program – Low Lying Fruit Best News Ever! Mostly because of target goal of decreasing Orthopedic Department Antibiotic Usage

Nikki Ripplinger / June 13, 2019 Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 Lessons Learned: Network with APIC Chapter and other facilities like yours in your region Everything I learned to get me started on ASP came from my APIC friends, through seminars or networking Get acquainted with the Centers for Disease Control’s website and the APIC website – they have endless resources, just study Seek out your grant writer, and find out what financial resources are available through your county, state and chapter leaders Read and/or attend your APIC chapter meetings – great advice and resources You know more than you think you do – study it out, be genuinely enthusiastic, earn the respect of your colleagues Support from Administration is crucial

Does Your Small Rural Hospital Have Limited Resources to Set Up Your ASP? Nikki Ripplinger / June 13, 2019 CDC Resource CDC Resource CDC Resource Antibiotic Stewardship in Acute Care: A Practical Playbook The Core Elements of Hospital Antibiotic Stewardship Programs Checklist Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals

Nikki Ripplinger, RN, IP, CIC Questions? Contact Information: Nikki Ripplinger, RN, IP, CIC Teton Valley Health 123 East Howard Driggs, ID 83422 nripplinger@tvhcare.org 208 354-6317 x138