ASB 101 team

• Noreen – lab manager
• Cassandra – IP/QI
• Liz Henry – Pharmacist

Characteristics

• Agricultural communities, 85% Medicare/Medicaid
• 25 beds, nursing home attached, small rural health clinic
• No doctors, one MD in clinic, group of locums that staff ED
  • No on staff providers
• Hospitalists – all locum, contract workers
• Medication review for pharmacy
• Do own micro – blood cultures, urine cultures, wound cultures
• In early stages of AMS program – make annual antibiogram, no active monitoring/feedback
  • Contract with Medici to meet NHSN AUR reporting – data will be easier to get, more accurate, standardized
    • Previously was manual data
  • Have physician representation – have defined group but not actively working on AMS
• Pharmacy – not currently reviewing antibiotic orders
  • Management team – focused on compliance
  • Tele pharmacy does orders
  • Does retrospective reviews – pull info but need to make it more useful for facility
• Data collection
  • Have not entered into Redcap yet – will train tech to enter data
    • Planned patient and physician IDs
    • All ER patients

Questions 

• Is their reflex criteria for urine cultures correct?
  • Current reflex criteria:
    • WBCs greater than 10, positive leukocytes AND nitrates, bacteria greater than 1+ AND epithelial count less than few or less
    • Pyuria – good indication for infection – should be reflexed
      • Leukocytes + nitrates could also be reflexed
    • Bacteria without preceding – less useful 
      • Currently on its own would prompt reflex – could be changed as intervention 
• What should lab be reporting from analysis of urine?
  • 2 pathogens – should be worked up, 3 or more – mixed flora
  • Report lower volume growth for clean catch (less than 10^5) – Alyssa will ask lab manager
    • Report all for catheter

Second check-in 2/22/24: 

• Trying to interface with Medici and abstract data for NHSN – been very difficult/frustrating
  • Working to publish antibiogram
  • NHSN taking priority over ASB
• Struggling to pick SMART goal
  • Never had capabilities to monitor antimicrobial use, not sure where to start
  • Difficult to have push with ER doctors because they are locums
    • Pharmacists also contracted
  • Pharmacist and providers accessible, good amount of face time, positive rapport
    • Connect with Beth again to discuss
• Present to Medstaff
  • Mentioned project in report in December
    • Dr. Scott interested
  • Peer review quarterly
  • Could provide report prior (send to Medstaff coordinator) and discuss at Medstaff
• Report
  • Thinking about distribution of data reports and how to loop in people previously interested
• Plan: Increase engagement on provider side –> Do: share tool that they are interested in (antibiogram)