Patient Safety First · Patient Safety First… a California Partnership for Health One of the...
Transcript of Patient Safety First · Patient Safety First… a California Partnership for Health One of the...
Patient Safety First
August Webinar Series
HAI Prevention and
Antimicrobial Stewardship
Collaborating with Pharmacy
Presented by Jason Lebowitz, PharmD
August 6, 2015
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.
Why are we here?
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
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
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
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.
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.
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.
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.
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.
Factors that promote
Healthcare Associated Infections
Colonized Patient
Hand Hygiene
Healthcare
Associated
Infections
12
Antimicrobial
Stewardship
Patient
Environment
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
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
“It takes a village”
Pharmacy
Infection
Prevention
Medicine
Nursing
Quality
Process
Improvement Safety
IT
Administration
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
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
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;
IP Responsibilities
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
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
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
S.M.A.R.T. Approach to ASP
Create S.M.A.R.T. goals that support your organizational goals for the same period.
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
Times are Changing
“What can you do by
next Tuesday?”
—Don Berwick, Past President,
Institute for Healthcare Improvement