Goal: 

• Speak at interdiscplinary huddle about AMS everyday – ASB comes up
  • Nursing – urine culture if patient has confusion
    • Providers lately have been saying it is ASB and to gold off

Data Collection: 

• Kate doing data – keeping spreadsheet to more easily enter data
  • In ER, on antibiotic – gets admitted to floor or discharged
• Questions
  • Evaluating provider vs prescribing provider
    • Want to capture prescribing provider (easier to see in chart and make ultimate decision about prescription)
    • Choose one method and keep consistent
    • Both prescribers – one IV, one PO
      • Would like to get both sets of providers
    • Start with first provider to capture momentum
      • For Skyline, get most benefit from continuing provider (hospitalist, admitting hospitalist)
        • Diff benefits when intervening at either level
    • Diagnositic momentum vs catching ASB in ER
  • Duration of therapy – capture all together (IV and oral)
  • Will do admitting provider
  • Meet first exclusion – do not enter data
• Puts in any one that gets a UA

Facility/AMS program background: 

• Been in TASP for 5 years
  • Had a site visit early on
  • Foundation and support for transforming use of antibiotics at Skyline
• Amy (pharmacy manager) and Kate (nurse IP)
  • Head hospitalist and supporting hospitalist have been supportive (provider buy-in – 80% of hospitalist coverage)
  • Kate has been at Skyline for 14 years
• Few weeks ago – had interdisciplinary huddle
  • Routine daily conversations using info from TASP – need to do fewer ID consults
• Patient population
  • Lower income, also have other side
  • Some drug abuse, no homeless population
  • Elderly (65-70+), don’t keep pediatrics
  • Swing bed – long term abx from larger facilities
  • outpatient infusion service
• In-patient beds: 12 beds – acute, obs and swing bed
• Urinalysis reflex – urine cultures sent to Labcorp
  • 3-5 days for results (5 days more common)
  • Follow cultures after discharge – sometimes reevaluate or reach out to PCP to change therapy
    • Hard to track lab results, can be missed (bad process)
• ER process – ED callback result
• Use Cerner community works
  • Does not flag as abnormal
• Staffing model
  • ER – contracted group – consistent
  • Hospitalist – consistent (2 that do bulk)
    • Most know system
  • Clinic relatively consistent as well
• AMS program:
  • Kate, Amy, Dr. Swanson (hospitalist and chief of staff), Heidi (quality manager)
    • Quality manager makes graphs, trends ABX use, benchmarking – presented quarterly at PNT then presented at medstaff)
  • Grant funding to pay for TASP – get a lot of buy-in from leadership meeting