Description
ASB 201
GS Health 1-22-23 Report
Core Elements
Education
Educating clinicians about resistance and optimal prescribing.
Reporting
Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff.
PDSA Cycles
Progress on PDSA Cycle 3
Follow up from last meeting actions:
- ER mid-level has joined stewardship committee and has been changing practices
- No one is using the order set since it is not a requirement – easier to just order abx they want
- Very busy ER for a CAH
Hardest challenge will be maintaining the progress being made
- Brought up to quality counsel if they want to continue monitoring this
In patient provider very involved and engaged with peers; ER provider not as much
- How to get ER providers information – email not a good option, too busy when on site to pull aside (maybe very first thing in the morning)
- Ask them how they would like to receive prescribing information
- Was supposed to be at ER monthly meeting, did not happen – hope to follow up in June
Great to see providers engaged, making change
Continuing interventions that were started
- Making decision in June on how to proceed when cohort ends
- Continue giving prescribers information on their prescribing habits
Progress on PDSA Cycle 2
Disseminate the January 201 report and deciding next steps
Shared at AMS meeting, medstaff, one-on-one with ER lead
- Areas of intervention: duration of antibiotics
- Discussed the categorization of ASB, concerns about altered mental status
- Concern the data collection tool was misclasifying true UTIs as ASB
- Defintions are conservative – overcalling UTI and undercalling ASB
- Provider breakdown – approach one-on-one providers with good ASB practices and ask to speak up at Medstaff
- Question to ask Julie: providers are prescribing abx out of fear of patient retaliation and legal action given the reflexed urine culture with positive results
- Order Set: Shared order set with providers that weren’t aware
- Seeing if durations improve
- Education: Shared table/one-pager on treating UTIs with ER provider
- Will print and put at ER workstations
- Provider breakdown – approach one-on-one providers with good ASB practices and ask to speak up at Medstaff
- Question to ask Julie: providers are prescriving
Progress on PDSA Cycle 1
- Have been doing a lot of data submissions
- Presented quick summary of 101 findings in Medstaff
- Were interested, not aware facility was participating in ASB 101
- Try scheduling separate meeting
- 4 ED prescribers – not very involved – don’t have bandwidth to get involve
- Send results, ask for feedback since it is mainly ER
- Duration of therapy – very low compared to peers
- Mitchell has started to review urine cultures and providing recommendations to prescribers (started doing in August) – mostly on inpatient side
- ER nurse that follows up with patients
Next steps:
- Community access for Epic (no direct control on order sets)
- Worked with partner hospital to create UTI order set
- Has line for ASB
- Sub disease states (cystitis, pilo)
- Providers not using order set, presented at clinical staff meeting
- Providers hesitant and pushed back on it – claimed it didn’t follow guidelines
- Would like to implement order set more
- Surgery director – physician lead for AMS
- Helpful with surgery department
- Could maybe help with ER providers
- Medical director for in patient on committee – involved, receptive and responsive
- Next time talking about order set – make sure committee prescribers are there to show support and intervene/respond to push back
- Emphasize it is guideline based
- Showing adherence to guideline is a requirement – back it up with CDC/JACO
- Nebraska has good resources
- Need to track adherence/use (present # of cases that don’t adhere to guidelines)