Description
1. Our Flex-ASB goal is to provide feedback on all inpatient, emergency department and clinic patient urine cultures that do not meet urinary tract infection (UTI) criteria within 2 weeks of urine culture (UC) results. Infection Preventionist (IP) will review all urine cultures for appropriateness. IP will forward all cases of UCs that may not meet UTI criteria to Antimicrobial Stewardship (AMS) provider (s) for final case review. The AMS provider will direct IP to follow up with ordering/treating provider with the case findings and education on Asymptomatic Bacteriuria (ASB) vs UTI. Tracking reports of outcome will be presented to AMS, providers and leadership. We would like to have this done by August, 2022.
2. Our second Flex-ASB goal is to provide UTI vs ASB education to the community (patients, family members, Home Health Care and Adult Care Services). The education will be provided in brochures and electronically on reader boards (waiting areas) and WhidbeyHealth Facebook, home web page and Pulse magazine. The education information will be initially set up and sent out by an AMS team member. Accomplishing this goal will aid the providers in saying “No” to antibiotics when appropriate while empowering the patient for optimal care.The brochures will be provided in reader racks and distributed during patient care visits when checking for UAs with UCs or reflex UCs. Home Health Care and Adult Care Services will be mailed the information including provider information (i.e. algorithms) with a cover letter for explanation of the information and opportunity for additional brochures for their patients. The electronic education will go out Quarterly by the marketing department. We will track and trend antibiotic usage to continue to drive down over utilization of antibiotics which in turn drives down MDROs and side effects (tendon rupture and peripheral neuropathy). We would like to have this implemented by August 2022.
Project Resources
Whidbey
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.
Education
Educating clinicians about resistance and optimal prescribing.
Leadership Commitment
Dedicating necessary human, financial and information technology resources.
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 2
Do a trend report for duration of abx give to determine where the higher days of therapy are coming from (prescriber location).
Your organization has completed the following PDSA cycles. Click a heading to view a cycle's details.
Change how the Urine Cultures are being tracked. Currently providing feedback for the inpatient and emergency departments. Plan to add the outpatient clinics, both walk in and primary care providers (different electronic system). Change from daily hand monitoring to electronic data pull through PowerBi.
Provide community education through marketing for the main community as well as outside facilities such as Home Health Care and the Adult Care Facilities. Address myths. Many urines are being submitted to the providers to order and treat without seeing the patients. The symptoms are often do not fit the clnical indications (dark or odorous urine, falls, confusion).
Urines are now tracked via PowerBi. Started with Inpatient and Emergency Department urine cultures in January, 2022. Clinic urine cultures were added in February, 2022.
UW TASP F-ASB data entry platform was turned on in February.
Data entries were initiated for Inpatient and Emergency patients end of February, 2022. Continued entering data for March and April of 2022.
Marketing department was given F-ASB brochures to brand with WhidbeyHealth end of February, 2022. Unexpected event of 4 Executive Leadership positions were terminated abruptly. Many other managers and other employees left because of it. Workload has increased on the marketing department. Brochure has 2 typos needed to be corrected before printing and releasing. Sent in request in March. Unable to have work done as of May 20, 2022.
Presented reports to AMS committee members immediately and at the Provider Meetings in May 2022. Reported up to Executive Summary and Patient Care, Safety and Quality meetings for June 2022.
Successful at utilizing the Urine Culture Data from PowerBi and using Meditech for clinical information to enter into the Flex program system. Obtained the excel data spreadsheet next day after data entry from UW TASP Flex ASB. IP IT volunteer able to create reports within the week of receiving excel data. Pleasantly surprised at the speed of the turnaround from data entry to the excel spreadsheet.
Have a downward trend of ESBL and C. diff after initiation of the UC order change and strict observation of every urine cultures. Follow up with provider tools, more education and outcome reports may have assisted in the continuation of the decrease in inappropriate use of antibiotics and the decrease in MDROs.
Staffing issues impacts the ability to provide quality patient education via brochures and in the EMR discharge instructions.
Plan to continue to track and provide feedback to the providers, including the MDRO rates.
Consider making the reflex order even stricter than it is.