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Patient Safety First August Webinar Series HAI Prevention and Antimicrobial Stewardship Collaborating with Pharmacy Presented by Jason Lebowitz, PharmD August 6, 2015

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Page 1: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Patient Safety First

August Webinar Series

HAI Prevention and

Antimicrobial Stewardship

Collaborating with Pharmacy

Presented by Jason Lebowitz, PharmD

August 6, 2015

Page 2: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Disclosures

I am an employee of CareFusion/

Becton Dickinson, a medical

technology company and provider of

electronic data mining surveillance

solutions.

The topics covered in this

presentation are those of my own,

and do not represent the thoughts

and opinions of my employer.

Page 3: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Why are we here?

Page 4: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

The Need: CDC Threat Report

“Preventing infections negates the need for

antibiotic use in the first place, and scientific

evidence shows that reducing antibiotic

use in a single facility can reduce

resistance in that facility. Taken on a

national scale, infection prevention efforts

can significantly decrease resistance.”

The “Threat Report” CDC

Page 5: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

3 Threat Levels and 18 “bugs”

Urgent Threats

1. Clostridium difficile

2. Carbapenem-resistant Enterobacteriaceae (CRE)

3. Drug-resistant Neisseria gonorrhoeae

Concerning Threats

1. Vancomycin-resistant Staphylococcus aureus (VRSA)

2. Erythromycin-resistant Group A Streptococcus

3. Clindamycin-resistant Group B Streptococcus

Serious Threats 1. Multidrug-resistant Acinetobacter

2. Drug-resistant Campylobacter

3. Fluconazole-resistant Candida (a fungus)

4. Extended spectrum β-lactamase producing Enterobacteriaceae (ESBLs)

5. Vancomycin-resistant Enterococcus (VRE)

6. Multidrug-resistant Pseudomonas aeruginosa

7. Drug-resistant Non-typhoidal Salmonella

8. Drug-resistant Salmonella Typhi

9. Drug-resistant Shigella

10. Methicillin-resistant Staphylococcus aureus (MRSA)

11. Drug-resistant Streptococcus pneumoniae

12. Drug-resistant tuberculosis

Page 6: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

PSF Project Background

Patient Safety First…

a California Partnership for Health

One of the largest State-wide Patient Safety

Collaboratives in the nation launched in 2010.

Funded by Anthem Blue Cross

A partnership of approximately 170 hospitals, the

three regional hospitals associations, the National

Health Foundation, Anthem Blue Cross, and the

Hospital Quality Institute

Page 7: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Patient Safety First Collaborative

2013-2015 Goals

PSF provides a forum for peer-to-peer learning, networking and sharing of best

practices to improve patient safety and clinical outcomes in the following four areas:

Sepsis Mortality: Improve early detection and management to decrease your mortality rate

by 10% (relative reduction) from your 2012 baseline.

HAI – C. difficile: Decrease your C. difficile infection rate by 10% (relative reduction) with

attention to environmental management, hand hygiene, PPE and antibiotic stewardship.

Perinatal Safety:

• Early Elective Deliveries: Achieve early elective delivery rate of <=3% of deliveries

between 37 & 38.6 weeks.

• Cesarean Section Rate: Achieve a rate of <= 23.9% for Low-risk First-birth (NTSV)

Cesarean Birth Rate

• Obstetrical Hemorrhage: Achieve no cases with 4 or more units of RBC

Surgical Safety: Learn reliable and inexpensive systematic approaches to surgical safety to

help eliminate the potential for retained surgical items, preventing returns to the OR.

Page 8: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

C. difficile-Associated Disease

Decrease your C. difficile infection rate

by 10% (relative reduction) with

attention to:

Environmental Management

Hand Hygiene

Personal Protective Equipment

Antibiotic Stewardship

HAI – C. difficile: Decrease your C. difficile infection rate by 10% (relative reduction)

with attention to environmental management, hand hygiene, PPE and antibiotic stewardship.

Page 9: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

C. difficile-Associated Disease Epidemiology

Worldwide

2-3% of adults are asymptomatic carriers of C.

difficile

50% of healthy neonates (<1 year old) are

carriers of C. difficile

C. difficile is the most common cause of abx-

associated diarrhea

Six strains of clostridia have been demonstrated

to be capable of producing the fulminant

condition known as clostridial gas gangrene

HAI – C. difficile: Decrease your C. difficile infection rate by 10% (relative reduction)

with attention to environmental management, hand hygiene, PPE and antibiotic stewardship.

Page 10: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

C. difficile-Associated Disease Organism Profile

CHARACTERISTICS: Produces two exotoxins.

Clostridia are gram-positive, anaerobic, spore-forming

bacilli commonly found throughout nature

Cultivated rich soil has the highest density of organisms. In

addition, clostridia have been isolated from normal human

colonic flora, skin, and the vagina. There are currently 150

strains of clostridia identified

INCUBATION PERIOD: Unknown

SURVIVAL OUTSIDE HOST: Spores can survive for long

periods (months or years) outside of host.

HAI – C. difficile: Decrease your C. difficile infection rate by 10% (relative reduction)

with attention to environmental management, hand hygiene, PPE and antibiotic stewardship.

Page 11: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

C. difficile-Associated Disease Pathogenesis and Transmission

Fecal-oral contact; transmission via fomites and hands

exists.

May be transmitted from person to person and shed in feces.

Any surface, device, or material (e.g., commodes, bathing tubs, and

electronic rectal thermometers) that becomes contaminated with

feces may serve as a reservoir for the Clostridium difficile spores.

Clostridium difficile spores are transferred to patients

mainly via the hands of healthcare personnel who have

touched a contaminated surface or item.

In the large intestine, CDAD can arise if normal flora

has been disrupted by antibiotic therapy

Germination and alteration

of normal gut flora Ingestion of spores

Growth and production

of toxins

HAI – C. difficile: Decrease your C. difficile infection rate by 10% (relative reduction)

with attention to environmental management, hand hygiene, PPE and antibiotic stewardship.

Page 12: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Factors that promote

Healthcare Associated Infections

Colonized Patient

Hand Hygiene

Healthcare

Associated

Infections

12

Antimicrobial

Stewardship

Patient

Environment

Page 13: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

A Shift to Pay-for-Performance Hospitals are now held financially accountable for readmissions, HAIs, and

other performance measures.

30-day outcomes: Unplanned

readmission and death rates

Surgical complications

Healthcare-associated infections

Government / CMS

Pay-for-Performance

Both Gov’t and Private Insurers alike are moving from FFS

to pay-for-performance reimbursement models.

ACOs are holding hospitals accountable

for quality and spending targets

Medical groups keep a share of what

they save as a bonus

Quality targets mirror Medicare in

more than 200 agreements

Private Insurers

Pay-for-Performance

2011 2012 2013 2014 2015 2016 2017

Page 14: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Improving Patient Safety Improved patient safety leads to improved quality

Better quality leads to increased productivity

and consistency of health care delivery.

Hospital efforts to reduce medication errors and HAIs must be evidenced-based, to

effectively improve patient safety and increase quality in a cost-conscious manner.

Phan, P. The Business of Safety. Johns Hopkins School of Medicine. Presented July 1, 2014.

Increased Quality

Improved

Patient Safety

Reduced

HAIs

Reduced

Medication Errors

Page 15: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

“It takes a village”

Pharmacy

Infection

Prevention

Medicine

Nursing

Quality

Process

Improvement Safety

IT

Administration

Page 16: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

The ASP Committee HAI – C. difficile: Decrease your C. difficile infection rate by 10% (relative reduction)

with attention to environmental management, hand hygiene, PPE and antibiotic stewardship.

Hospital

Administrator Infectious

Diseases

Division

Hospital

Epidemiologist

Core ASP Members

• ID Physician / Fellow

• ID Pharmacist

(or Clinical Pharmacist)

Outcomes

Research

Infection

Prevention/

Control

Chairman, P&T

Committee

Other

Disciplinary

Partners

Microbiology

Laboratory Pharmacy

Specialists Medical

Information

Systems

Page 17: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Pharmacy

Technician

Pharmacy

Technician

Pharmacy

Technician

Pharmacy

Technician

Pharmacy

Technician

Pharmacy

Technician

Pharmacy

Technician

Clinical

Pharmacist

Clinical

Pharmacist

Clinical

Pharmacist

Clinical

Pharmacist

Collaborating with Pharmacy HAI – C. difficile: Decrease your C. difficile infection rate by 10% (relative reduction)

with attention to environmental management, hand hygiene, PPE and antibiotic stewardship.

Pharmacy Department

ASP Committee

Clinical

Pharmacist

Clinical

Coordinator

Clinical

Coordinator

Clinical

Coordinator

Pharmacy

Manager

ID

Pharmacist

ID

Physician

Clinical Ops Nursing Quality Medicine

Director of

Pharmacy

Page 18: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Roles of Clinical Pharmacy

Promote the rational prescribing and use of drugs;

Influence selection of drugs and dosage regimens, monitor patient compliance and therapeutic response

Recognize and report adverse drug reactions;

Assess and monitor patterns of drug usage and recommend changes where necessary;

Educate other health professionals about the rational use of drugs;

Serves on policy-making committees concerned with drug selection, the use of antibiotics, and hospital infections, influencing the preparation and composition of an essential-drug list or formulary;

Participate in studies to determine the beneficial or adverse effects of drugs;

Control hospital manufacture and procurement of drugs to ensure the supply of high-quality products;

Page 19: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

IP Responsibilities

Page 20: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Roles of Infection Prevention

Prevention of HAIs in patients and

healthcare workers

Prevent the emergence and transmission

of antimicrobial resistance

1. Decrease Abx. Usage

2. Isolation Practices

3. Environmental Cleaning

Page 21: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Collaborating with Pharmacy

Surveillance for HAIs

Education

Hand Hygiene

PPE

Precautions

Active Surveillance

HAI – C. difficile: Decrease your C. difficile infection rate by 10% (relative reduction)

with attention to environmental management, hand hygiene, PPE and antibiotic stewardship.

Infection Prevention

ASP Committee

IP

ASP Liaison IP

Director of

Infection Control

IP

ID

Pharmacist

ID

Physician

Clinical Ops Nursing Quality Medicine

IP IP

Page 22: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

S.M.A.R.T. Approach to ASP

Create S.M.A.R.T. goals that support

your organizational goals for the

same period. A S.M.A.R.T. goal is:

Specific

Measurable

Achievable

Results-focused

Time- bound

Page 23: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

S.M.A.R.T. Approach to ASP

Create S.M.A.R.T. goals that support your organizational goals for the same period.

Page 24: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Times are Changing

“In a study of how multidisciplinary teams

achieved practice improvements in the

area of antimicrobial resistance, Olson

et al found that teams used local clinical

data as one form of credible evidence to

influence key stakeholders, and strong

professional relationships were a

critical component of success.”

Olson CA, Tooman TR, Alvarado CJ. Knowledge systems, health care teams, and clinical practice: a

study of successful change. Adv Health Sci Educ Theory Pract. 2010;15:491–516 CrossRef

Page 25: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Times are Changing

“What can you do by

next Tuesday?”

—Don Berwick, Past President,

Institute for Healthcare Improvement

Page 26: Patient Safety First · Patient Safety First… a California Partnership for Health One of the largest State-wide Patient Safety Collaboratives in the nation launched in 2010. Funded

Questions?

Jason Lebowitz, PharmD

[email protected]

THANK YOU!

mailto:[email protected]

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