1. 2109 Antibiotic Stewardship Programs with Limited Resources
Nikki Ripplinger, RN, IP, CIC, Employee Health
Thursday, June 13
no financial disclosures

2. 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

3. 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 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:

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. 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

14. Nikki Ripplinger, RN, IP, CIC
Questions?
Contact Information:
Nikki Ripplinger, RN, IP, CIC
Teton Valley Health
123 East Howard
Driggs, ID 83422
x138