Aug 30, 2016 - U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-
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WiTAP Antimicrobial Stewardship Program August 30, 2016 Jill Hanson, WHA DeAnn Richards, MetaStar
Objectives for Today • Participants will have a better understanding of Wisconsin’s Antimicrobial Stewardship Program (ASP) Landscape. • Participants will learn about the Antimicrobial Stewardship Targeted Assessment for Prevention (TAP) strategies, including TAP report, TAP Tool, and TAP resources. • Participants will understand the next steps in the ASP statewide tool rollout.
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Status of the State Looking Back at 2014 and 2015
ABX Stewardship Project • Co-supported by WHA and MetaStar • 20 hospitals participating • Hospitals range in number of beds and locations • Started with CDC Core Elements as a discussion item
• Received input from hospitals that the CDC elements were a great place to start, but they still needed direction • Started brainstorming on additional elements and needs
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Results • Input received during teleconferences and written suggestions via email were used to create a TAP-style tool. • The draft tool was reviewed twice, noting possible improvements after each attempt. • The final tool provides additional considerations and strategies to consider during an initial gap analysis.
January 2016 Polling Responses The following reflects the current state of my hospital’s ASP: • We have extensive experience and have impacted our antimicrobial resistance - 0% • We have moderate experience and are making progress - 14% • We have limited experience with an ASP - 27% • We have no experience with an ASP - 18% • No answer - 41%
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Wisconsin’s Landscape What is your biggest hurdle with starting an ASP in your organization? • Other competing priorities - 31% • We don’t have a champion to lead the team - 12% • Leadership support - 12% • Drug expertise - 8% • IT limitations - 8% • No answer - 31%
Prescribing Approaches Which of the following interventions have you implemented related to antibiotic prescribing (select all that apply)? • Broad (e.g., time out, “look back” for appropriate use) 17% • Pharmacy-driven (e.g., P&T Committee/governing body approving interventions to be implemented) - 24% • Diagnosis and Infections Specific (e.g., UTI, MRSA) 24% • We don’t have any yet - 31% • No answer - 21%
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Draft Overall Results
WI NHSN Annual Survey
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WI NHSN Annual Survey
Lessons Learned • Collaboration resulted in valuable discussions, based upon experience and implementation barriers. • As a result, additional questions and formatting changes to the original CDC document were made to allow all hospitals, regardless of size and resources, to implement or improve their current ASP.
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Accreditation Standard from The Joint Commission •
• •
Late in 2015, The Joint Commission proposed an accreditation standard for antibiotic stewardship in all healthcare facilities. The standard has eight performance elements. They have been accepted and will be required as of January 2017.
Accreditation Standard from The Joint Commission Element 1: Leaders establish antimicrobial stewardship as an organizational priority. Element 2: The [critical access] hospital educates staff and licensed independent practitioners involved in antimicrobial ordering, dispensing, administration, and monitoring: • About antimicrobial resistance and antimicrobial stewardship practices • Upon hire or granting of initial privileges and periodically thereafter • Based on organizational need
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Accreditation Standard from The Joint Commission Element 3: The [critical access] hospital educates patients, and their families as needed, regarding the appropriate use of antimicrobial medications, including antibiotics. Element 4: The [critical access] hospital has an antimicrobial stewardship multidisciplinary team that includes the following members, when available in the setting: • • • •
Infectious disease physician Infection preventionist(s) Pharmacist(s) Practitioner
Accreditation Standard from The Joint Commission Element 5: The (critical access) hospital’s ASP includes the following core elements: • • • • • • •
Leadership commitment Accountability Drug expertise Action Tracking Reporting Education
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Accreditation Standard from The Joint Commission Element 6: The [critical access] hospital’s ASP uses organization-approved multidisciplinary protocols. Element 7: The [critical access] hospital collects, analyzes, and reports data on its ASP. Element 8: The [critical access] hospital takes action on improvement opportunities identified in its ASP.
WiTAP Tool Kit
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WiTAP Milestone and Timeline
http://bit.ly/2aVkNTC
WiTAP Milestone and Timeline
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TAP Current Status Report
http://bit.ly/1UAgY3E
TAP Assessment Tool – Instructions
http://bit.ly/1r5bjbp
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TAP Assessment Tool – Instructions
TAP Assessment Tool – Screening Questions
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TAP Assessment Results
TAP Utilization Guide
http://bit.ly/1P9yTdj
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Phase Two
http://bit.ly/29OOG7E
Phase Two
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Phase Two
Phase Two
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Leadership Support
http://bit.ly/2a2H5hX
Resources • WI Milestone and Timeline: http://bit.ly/2aVkNTC
• WI ASP Current Status TAP Report: http://bit.ly/1UAgY3E • WI ASP TAP Assessment Template 2016: http://bit.ly/1r5bjbp • WI ASP Implementation Guide: http://bit.ly/1P9yTdj • WI Phase Two Steps: http://bit.ly/29OOG7E • WI Documentation of Leadership Support: http://bit.ly/2a2H5hX
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Questions? Thank you! Jill Hanson (
[email protected]) DeAnn Richards (
[email protected]) This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-WI-C1-16-100 080316
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