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Finding Local Solutions to Emerging Health Challenges

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ASB 201

Description

TBD

Core Elements

Education

Educating clinicians about resistance and optimal prescribing.

PDSA Cycles

Progress on PDSA Cycle 1

2/8/24 Check-in: 

  • Hired new hospitalists recently
    • Try to get onboard/support AMS
  • Starting with education to minimize friction
  • Working on CAP
  • Trying to get in front of providers and update on one new guideline that has changed

Frist Check-in – Review: 

  • Nurses see altered mental status as indicator of UTI, difficult to accept ASB
    • Emily Spivak presentation [reviewed]
    • Johns Hopkins – nurse steward presentations
  • Trying to get to other areas
    • Speaking to med staff education next month (beginning of December) –
      • For inpatient and outpatient physicians
      • New guidelines presented at IDweek – Whitney will sent
      • Low cases from ASB 101 submissions – shows long days of therapy
    • Will also discuss SAR data
  • New clinical inpatient manager
    • Started presentation talks with pharmacists
    • First presentation went over CSiM pocket guide
    • Second presentation went over Pen allergies
    • Third presentation – same as the one for nurses
    • Do individual ASB education as well
  • Sydney had cards
    • Lauren wants to do similar as physicians recommended it
  • Starting with IP to work on surgery prophylaxis
    • Providence community connect
      • All of providence order sets
    • Urine cultures on pre-op order sets
      • Providence community works – wants to submit ticket to remove from order set
  • ED – different workup and mind frame
    • Nurse expectation different
    • used to do urine culture review with prior ED group (had  wrong DOT)
    • Discrepancy in guidelines
      • Number of days of fluroquinolone in ED literature is 5 days
    • Will talk with head of ED, just started 2 months ago
  • Sydney’s algorithm – will upload to website and forward

Question

  • Removed urologic procedures – will not be entering cases with urologic procedures

Second check-in:

  • Watched Spivak’s presentation, did literature review, covered information and some newer guidelines at meeting

First Check-in:

Education has been completed: ICU/Tele RNs, Med Staff Education presentation, Staff pharmacists

Unexpected problems: multiple attempts to meet with Hospitalist directors have failed, Med/Surg RNs with infrequent meetings

Second check-in 2/8/24: 

  • Presented in December
    • Only 3 physicians came to meeting, poor provider buy-in
  • All outpatient physicians that came, not much feedback
  • CMO unable to make it, asked for presentation, forwarded to hospitalists
  • Forwarded to community practice team
  • Have been trying to schedule meeting with hospitalist director
  • Culture at facility not focused on group

First check-in: 

Implementation lessons: continued lack of general buy in

Poor medical staff education turn out

Lack of communication from: Hospitalist and NOHN directors despite attempts

Hospitalist issue: scheduled another meeting with Director for 02/14. CMO notified of issues in communication. Instead of waiting for calendar acceptance – I am going to prepare for the meeting and manifest that he will show up. If not, will consult CMO for advice

Med/Surg RN issue: printed Valor Health education. Am planning on posting in all RN break rooms, med staff lounge. Vacant Med/Surg educator position possibly filled in the next few months so will also plan on working with that position once available.