4/25/24 Check-in:

• Data report decemination
• Monthly med staff meetings
  • Next meeting today – next one in May
  • Consider presenting data at Medstaff meeting – get time on agenda
  • MDs, NPs, CEO, COO, board member, medical director of lab, clinical directors
• Schedule another meeting to discuss before 5/23 meeting
• Quarterly antibiotic stewardship meeting
• NPs more engaged at Medstaff meetings
  • Consider what the ask is for stakeholders
• Consider looking at ASB cases during peer review process

Engagement not at desired level

• Change approach to dissemination and buy-in

Previous intervention: reduce abx use through peer review –> implemented –> intervention did not gain sufficient traction/buy-in

Used to do physician report card with stats (patients seen, abx prescriptions out of ER) – physician got offended about this being seen by others

• Have policy about tracking opioids prescription

4/25/24 Check-in:

• Decide on project to implement that would work across settings

• Ideas:
  • High fluoroquinolone use – in one provider
    • More receptive if peer reaches out about fluoroquinolone
  • To collect or not to collect campaign
  • Print out card on diagnosis and treatment as smaller scale pocket cards
• Consider if there is a physician that would be interested in championing stewardship
• There is some provider buy-in when AMS committee member reaches out (with encouragement)
• Possibly deidentified physician comparison report

Submit urine cultures

Facility and AMS Program Background

• 2017 AMS program started
• Kate Cook – champion
• Attending physician champion
  • other 2 attendings on committee
  • 3 NPs on committee from clinic
  • HIM director/QA
• Quarterly meetings – during lunch hour
• Review ABX 48-72 hours
• Physicians sign off on paperwork
• Peg tracks data
• Connie ER – review cases
  • Brings peer review cases to committee
  • Did upper respiratory prior
• Lab service – urine diagnostics
  • urinalysis in house
  • cultures get sent out (no micro in house)
    • 2-3 days
    • First what they found, then sensitivities
• Reflex for urinalysis – depends on amount of bacteria, nitrate presence
  • Some doctors will order culture regardless
  • In house physicians do UA with culture if reflex
• Employee AMS education during onboarding process
  • Powerpoint followed by quiz
  • Present in orientation followed by post-test
    • Go through their role in AMS (housekeeping, business office – their role as a patient)
  • Community outreach – going to Senior event to present about antibiotic awareness

Data collection 

• Admin approved shared drive
  • Change Redcap survey to excel sheet
• SQL report that will pull patients that got a urine culture from all settings (ER, in-patient, clinic)
  • Select sampling and put into excel sheet

Goal brainstorming 

• Shifted committee from upper respiratory to UTIs
  • First meeting in Oct since April
• A lot of charts with not enough charting to even warrant a urine collection
• Patient sent home on inappropriate medication
  • for example, Fluroquinolone for 10 days
• Another goal: UTI order set (admitted to floor from ER)
  • Create one