Description
SMART Goal:
Reduce ASB urine cultures in our ambulatory clinics by 25% after provider education and distribution of resources.
Project Resources
Lincoln
Lincoln_Baseline submissions
This was laminated and distributed to providers with the ASB algorithm on the back in March 2023
After presenting at Med Staff, this document was used for individual provider education.
This brochure was distributed to a few providers who requested more information.
This is the algorithm that was laminated on the back of the antibiogram.
Lincoln Case Submissions
Lincoln Final Report
Core Elements
Accountability
Appointing a single leader responsible for program outcomes. Experience with successful programs show that a physician leader is effective.
Action
Appointing a single leader responsible for program outcomes. Experience with successful programs show that a physician leader is effective.
Drug Expertise
Appointing a single leader responsible for program outcomes. Experience with successful programs show that a physician leader is effective.
Education
Educating clinicians about resistance and optimal prescribing.
Reporting
Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff.
Tracking
Monitoring antibiotic prescribing and resistance patterns.
PDSA Cycles
Progress on PDSA Cycle 3
Baseline Data and ASB Education will be provided to individual providers, along with the antibiogram.
Merilla will spend March putting together the data and the plan for individual provider education.
An overview of this plan was presented to Medical Staff on 3/7/23.
During a 1:1 session with Dr. Lynch, Whitney, and Chloe, they provided valuable suggestions regarding the antibiogram and also shared algorithms we can utilize as part of our educational campaign.
The goal will be to complete education by the end of March, then once again begin data collection in April until the end of May when the next data collection cycle is complete.
Crystal and Merilla will not continue to enter data during the month of March but instead focus on the educational program aspect of this project.
It took much longer to prepare the materials and meet with each provider on an individual basis than expected.
By the end of April all providers will be educated with the antibiogram as well as the slides I prepared for ASB. Most were receptive to the info — but wanted it to not be more than a 5 minute conversation. The laminated antibiogram with the ASB algorithm on the back has been distributed and will hopefully be a valuable tool.
The new providers were the most appreciative and actually requested additional information. I think the more veteran providers mostly took note we were monitoring the situation.
We will adopt and continue to monitor and touch bases with the providers over the next few months to see if any questions arise.
We will start entering data again for the next cycle in April – May 31st to see if we see any improvement with documentation or reduced cultures from the clinics.
Your organization has completed the following PDSA cycles. Click a heading to view a cycle's details.
Analyze our first round of data collection that was completed in the fall to determine next steps and define our SMART goal for the project.
After we received our raw data from Whitney, Merilla crunched the numbers. Crystal and Merilla then reviewed the data at P&T to start determining the SMART goal and next steps.
Difficulties: The raw data contained a LOT of information. I am not an excel expert – so it was quite time consuming to figure out how to dissect the data into usable information. Google was very helpful in this process!
Observations from our data:
105/160 Entries were from the ambulatory Clinic
87/105 of the NBMC Cultures were from female patients
24/94 patients had no symptoms
14/24 patients were prescribed antibiotics
8/24 had a negative UA but still had a culture sent.
This data was presented to P&T along with our most recent antibiogram in February.
Dr. Panke was instantly interested in individual provider level data and asked for that to be extracted and communicated.
Seeing a 24% rate of asmyptomatic patients have a culture ordered was higher than we expected.
We will adopt this trajectory and expand to provider level data before presenting and providing education to individual providers.
1. Submit data to IQIC tool from LHD Inpatients, ER patients, NBMC Patients, and TCU Swingbed patients.
Crystal will submit data for outpatients.
Merilla will submit data for inpatients and swingbed patients until 12/31/22.
Merilla went on vacation x 4 weeks in November – so Crystal collected data reports to share with me upon my return. I was able to enter the data prior to the cut off date of 12/31/22.
Crystal noted it was sometimes difficult to determine all the necessary attributes being requested by the tool for the clinic patients since many of their UAs were dipsticks vs a UA from the micro lab.
Crystal was finding she was entering the vast majority of data from the outpatient side. Prior to starting this project — we weren’t really sure what the actual numbers were going to look like.
For our follow up data entry after our 1st intervention, Crystal may like some assistance. We will have to discuss.