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1Operating Plan AHRQ Safety Program for Improving Antibiotic Use

March 2017

AHRQ Safety Program for Improving Antibiotic Use

Operating Plan

March 2nd, 2017

Prepared for:

Agency for Healthcare Research and Quality

U.S. Department of Health and Human Services

Contract Number: HHSP233201500020I_HHSP23337003T

Johns Hopkins Medicine IRB #s IRB00112077, IRB00128248

JHU: Sara Cosgrove, MD, MS and Pranita Tamma, MD, MHS

NORC: Prashila Dullabh, MD

Prepared by:

Johns Hopkins University and NORC


March 2017

Table of Contents Welcome ......................................................................................................................................... 4

Overview of Project .................................................................................................................... 4

Target Audience .......................................................................................................................... 4

Operating Plan Updates .............................................................................................................. 4

Key Terms ........................................................................................................................................ 5

Phase 1: Planning ............................................................................................................................ 6

At A Glance .................................................................................................................................. 6

Description .................................................................................................................................. 6

Phase 1: Planning Deliverables ................................................................................................... 9

Phase 1: Planning Activities ...................................................................................................... 10

Phase 2: Onboarding (April 2017) ................................................................................................. 11

At a Glance ................................................................................................................................ 11

Description ................................................................................................................................ 11

Phase 2: Onboarding Deliverables ............................................................................................ 14

Phase 3: Implementation (July 2017 – March 2018) .................................................................... 15

At a Glance ................................................................................................................................ 15

Description ................................................................................................................................ 15

Phase 3: Implementation Activities .......................................................................................... 16

Phase 4: Sustainability (February 2018 and on) ........................................................................... 17

Appendices .................................................................................................................................... 18

Appendix A: Site Recruitment Letter – Acute Care Setting ...................................................... 19

Appendix B: Site Recruitment Letter – Long‐Term Care Setting .............................................. 21

Appendix C: Site Recruitment Letter – Ambulatory Care Setting ............................................. 23

Appendix D: Acute Care Team Commitment Form .................................................................. 25

Appendix E: Long‐Term Care Team Commitment Form ........................................................... 29

Appendix F: Ambulatory Care Team Commitment Form ......................................................... 33

Appendix G: Draft Data Use Agreement ................................................................................... 37

Appendix H: Acute Care Call Schedule ...................................................................................... 43

Appendix I: Long‐Term Care Call Schedule ............................................................................... 48


March 2017

Appendix J: Ambulatory Care Call Schedule ............................................................................. 53

Appendix K: Acute Care Team Roster ....................................................................................... 57

Appendix L: Long‐Term Care Team Roster ............................................................................... 59

Appendix M: Ambulatory Care Team Roster ............................................................................ 61

Appendix N: Timeline for All Site Types .................................................................................... 63


March 2017

Welcome

Welcome to the AHRQ Safety Program for Improving Antibiotic Use. We are excited to have your group onboard and participating in this project.

Overview of Project

This is a 5‐year AHRQ‐funded collaborative with the goal of developing and expanding antibiotic stewardship programs and improving antibiotic prescribing practices around the United States. All U.S. acute care hospitals, long‐term care facilities and ambulatory care facilities are invited to participate in the AHRQ Safety Program.

There will be four cohorts in this project, each with a duration of one year. Cohort 1 is the pilot period. It will begin with a 3‐month baseline period in April, 2017 and a 9‐month implementation beginning in July 2017. Acute care hospitals, long‐term care facilities and ambulatory care facilities are involved in this pilot year. The intervention for all site‐types will focus on developing antibiotic stewardship programs and teaching clinicians how to improve their antibiotic prescribing practices.

Target Audience

Coordinating entities include: Carolinas Healthcare System, Geisinger Health System and Johns Hopkins Health System.

Operating Plan Updates

This project will be overseen by AHRQ and be a collaborative effort between the national project team (Johns Hopkins University (JHU) and NORC), and the participating clinical teams. Based on what is learned over time, this document will continue to evolve with each cohort. If you have suggested edits, information to include, questions, or a request for clarification, please contact the national project team at [email protected].


March 2017

Key Terms

AHRQ Agency for Healthcare Research and Quality

Safety Program AHRQ Safety Program for Improving Antibiotic Use

CUSP Comprehensive Unit‐Based Safety Program

DUA Data Use Agreement

HIIN Health Improvement Innovation Network

HSOPS Hospital Survey on Patient Safety

IRB Institutional Review Board

JHU Johns Hopkins University

MOSOPS Medical Office Survey on Patient Safety

NHSOPS Nursing Home Survey on Patient Safety

NORC NORC (at the University of Chicago)

NPT National Project Team (JHU and NORC)

QIN/QIOs Quality Improvement Networks/Quality Improvement Organizations


March 2017

Phase 1: Planning

At A Glance

Receive and review the Operating Plan

Receive the recruitment package

Start recruiting sites (acute care hospitals and units, long‐term care facilities and ambulatory care facilities)

Review and complete the Coordinating Entity Commitment Letter

Email sites all required materials, and collect completed documents before project launch

Facility Letter of Commitment

Facility Data Use Agreement

Collect facility and site information for registration, as appropriate

Review Implementation Guide

Attend Stakeholder Meeting

Description

Operating Plan

The document in hand is the Operating Plan. Within this copy you will find details of the project including the roles, responsibilities, duties, and timelines for the Team Leaders (e.g., acute care = medical director, nurse leader, pharmacist; LTC = medical director and nurse leader; ambulatory = physician and nurse). If an Antibiotic Stewardship Team already exists at an acute care facility, the Stewardship Team (called Stewardship Coordinating Team for this project) will work closely with training the Team Leaders. If there is no existing Antibiotic Stewardship Team, the Team Leaders will be trained to become the Stewardship Coordinating Team. The Operating Plan is meant to provide and outline the project to help Team Leaders and Stewardship Coordinating Teams navigate the participation requirements.

Recruitment Package


March 2017

To help with the recruitment process, the NPT has created packaged recruitment materials. A project flyer will be sent to at least one Stewardship Coordinating Team and Team member for each participating site.

Start Recruiting Sites

Site recruitment should be completed by the end of March 2017.

Letter of Commitment and Data Use Agreement (Facility)

Participating facilities will submit a letter of commitment that will be returned to the NPT. The form indicates the facility’s commitment to the project and needs to be signed by a senior executive of the facility. All site‐specific project leads participating in the project also need to review the information outlined.

Facility IRB Approval

The AHRQ Safety Program is subject to IRB oversight and is approved by Johns Hopkins University School of Medicine IRB (Johns Hopkins IRB #s IRB00112077 and IRB00128248). Participation in this project may not require IRB approval at the facility level. It is best if each site contacts their IRB for advice on how to proceed. If required, the NPT will share the IRB documents used to obtain approval at the Johns Hopkins University.

Facility Data Use Agreement (DUA)

The DUA is a contractual agreement allowing the transfer of data from facilities to the NPT. These data will be housed within a database administered by NORC. Providing your data for this project will allow the NPT to give you feedback about your facility’s or unit’s progress through data reports.

Site Information for Registration

Information regarding the participating site will be needed to register in the project portal. Information needed includes items such as facility address, size, and type.

Implementation Guide

The implementation guide will help The Stewardship Coordinating Team and/or Team Leaders implement The AHRQ Safety Program within participating facilities.

Stakeholder and Train‐the‐Trainer Meeting

This meeting is for The Stewardship Coordinating Team and/or Team Leaders to review all project information with the NPT. The project will be explained in the day‐long meeting, and time will be allowed for open discussion. The NPT will work with The Stewardship Coordinating Team and/or Team Leaders to assist them in becoming Master Trainers and Change Agents for the project, as well as a resource for their team(s). This meeting is scheduled for March 21st, 2017.


March 2017

Data Portal Workshop and Project Website

The homepage for the project is accessible with the following URL:

SafetyProgram4AntibioticStewardship.org

Here, The Stewardship Coordinating Team, Team Leaders and frontline staff will be able to access eLearning modules, recorded webinars, data collection forms, other tools, and the data entry platform. In addition, they will be able to view and download data reports, and administer Hospital Survey on Patient Safety Culture (HSOPS), Nursing Home Survey on Patient Safety Culture (NHSOPS), and Medical Office Survey on Patient Safety Culture (MOSOPS), as necessary.

NORC’s Liberty platform will be the data portal used for collecting and analyzing project‐related data. The website structure and materials were created by the NPT. A webinar will be hosted during onboarding sessions to discuss an overview of the program, the call schedule with topics and objectives outlined, data importing and exporting, and available reports.


March 2017

Phase 1: Planning Deliverables Date Provided

Deliverable Description Appendix Provided by

Timeline/Details

February 2017

Recruitment Package NPT

March 2017

Data Use Agreement A NPT

March 2017

Operating Plan NPT

March 2017

Facility Commitment Letter

C NPT Email to [email protected]

Or

Fax to 410‐637‐4380

By April 15th, 2017

April 2017 IRB approval form (if required by your site)

Email to [email protected]

Or

Fax to 410‐637‐4380

By April 15th, 2017

April 2017 Implementation Toolkit NPT To be reviewed prior to July 1st, 2017


March 2017

Phase 1: Planning Activities Date of Activity Activity Description

January 2017 – March 2017 Recruitment

March 21st, 2017 Stakeholder Meeting


March 2017

Phase 2: Onboarding (April 2017)

At a Glance

Register teams

Develop team rosters and identify Team Leaders

Attend Onboarding Webinars

Set up process to import baseline data

Have teams complete HSOPS, NHSOPS or MOSOPS survey as appropriate (or import existing survey data)

Have Stewardship Coordinating Team of Team Leader complete the Structural Assessment

Description Team Registration

The NPT will provide The Stewardship Coordinating Team or Team Leaders with a registration form to distribute to their participating sites, Information collected from this registration form will include name, facility affiliation, position and project role. The Stewardship Coordinating Team or Team Leaders will be asked to collect these forms from their teams and send to the NPT. NPT will gather this information and use it to enroll all participants into the password‐protected website portal where data are collected and educational materials can be retrieved.

Team Roster

The team roster should include contact information for the core members from each participating site. The form will ensure that all appropriate contacts are included in project communications.

Onboarding Webinars

The Onboarding webinars will consist of two one‐hour webinars for acute care, LTC and ambulatory care, each, to be held in April 2017. These webinars will provide an overview of the AHRQ Safety Program.

For Acute Care

Onboarding Call #1


March 2017

o Goals of The AHRQ Safety Program

o The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the current program

o The timeline of The AHRQ Safety Program

o Technical and adaptive components of the educational toolkit

Onboarding Call #2

o The Four Moments of Antibiotic Decision‐Making

o How the CUSP approach can improve safety culture

o Uploading and accessing data on the AHRQ Safety Program website

o How to use the “Appropriateness Tool” to review antibiotic use with frontline staff

For LTC

Onboarding Call #1


o The Centers of Medicare and Medicaid Services requirements for participation related to Antibiotic Stewardship in the LTC setting

o Timeline of The AHRQ Safety Program

Onboarding Call #2


o Technical and adaptive components included in the educational toolkit

o Uploading and accessing data on The AHRQ Safety Program website

For Ambulatory Care

Onboarding Call #1


o Review The Centers for Disease Control and Prevention Core Elements for Outpatient Antibiotic Stewardship

o Timeline of The AHRQ Safety Program

Onboarding Call #2


o Technical and adaptive components included in the educational toolkit


March 2017

o Uploading and accessing data on the The AHRQ Safety Program website

Baseline Data

Facilities are asked to provide 3 months of baseline data. Baseline data can be collected retrospectively and covers the first three‐months of the project – April to June, 2017. Baseline data will be collected for the following measures:

Acute Care

1. Days of antibiotic therapy per 1,000 patient days (monthly)

2. Clostridium difficile laboratory event episodes per 10,000 patient days by unit (quarterly)

3. Review of at least 10 patients per month by Team Leaders and/or frontline staff with the Stewardship Coordinating Team using the Antibiotic Appropriateness Tool.

LTC

1. Days of antibiotic therapy per 1,000 patient days (monthly)

2. Number of urine cultures obtained per 1,000 patient days (monthly

Ambulatory

1. Antibiotic prescriptions per 100 patient visits

2. The proportion of antibiotic use for non‐antibiotic indicated respiratory conditions

Surveys on Patient Safety Culture (SOPS)

We will be using three versions of the SOPS survey. For acute care facilities, we will use the Hospital Survey on Patient Safety Culture (HSOPS). For LTC facilities, we will use the Nursing Home Survey on Patient Safety Culture (NHSOPS). And, for ambulatory care facilities, we will use the Medical Office Survey on Patient Safety Culture (MOSOPS). These surveys will be administered at the launch of the cohort and repeated at the end of the project, in February/March 2018. For sites that already complete these surveys, we will use available survey data.

Structural Assessment

The Structural Assessment is designed to help us understand where a site’s infrastructure and where sites stand in their development of their Antibiotic Stewardship Program. This survey will be administered to all site‐types at the launch of the cohort and repeated at the end of the project, in February/March 2018.

Interviews

In order to better understand behavioral factors influencing antibiotic prescribing, we will be conducting in‐person site visits with semi‐structured discussions with clinical


March 2017

staff at selected sites. These interviews will be taking place during the baseline and throughout the implementation period.

Phase 2: Onboarding Deliverables Date Provided

Deliverable Description

Appendix Provided by Timeline/Details

March 2017

Team Roster Stewardship Coordinating Team/Team Leader

Electronically Submit to antibiotic [email protected] by May 1st, 2017

April 2017

Baseline Data Sites enter manually or import into data portal

Begins April 2017

April‐May 2017

Surveys on Patient Safety Culture

Sites participate in survey or upload existing survey data into data portal

Begins April 2017

May 15, 2017

Register Team Stewardship Coordinating Team or Team Leader registers team in the project website

To be completed prior to implementation period

May 2017 Structural Assessment

Team leads will fill out the assessment in the project data portal

To be completed prior to implementation period


March 2017

Phase 3: Implementation (July 2017 – March 2018)

At a Glance

Participate in content calls with teams

Feedback data reports from the data portal to teams

Identify teams that might need additional follow‐up

Description Content Calls

Content calls will be hosted by the NPT bimonthly‐monthly for the acute care and LTC setting and monthly for the ambulatory care setting. The target audience for some calls may vary but will generally include The Stewardship Coordinating Team, Team Leaders, and frontline staff. The content calls will include both technical and adaptive components to improve antibiotic prescribing and will also guide sites on how to develop Antibiotic Stewardship Programs.

Feedback of data

To make the greatest impact, reports need to be fed back to the hospital teams in a timely manner. Set aside time to have a discussion with each site and review data as needed.


March 2017

Phase 3: Implementation Activities Date Provided Deliverable

Description Appendix Provided

by Timeline/Details

July 2017 through March 2018

Submit data Facility Teams

See data collection schedule in Appendix

February/March 2018

HSOPs

NHSOPS

MOSOPS

Facility Teams

Content Call Schedule

Content Calls NPT Stewardship Coordinating Teams, Team Leaders, frontline staff


March 2017

Phase 4: Sustainability (February 2018 and on)

The objective of the AHRQ Safety Program for Improving Antibiotic Use is to help sites further develop their antibiotic stewardship program and to improve the use of antibiotics at acute care, LTC and ambulatory care sites. Additionally, this project is intended to improve safety culture, enhance teamwork and communication, and improve patient, family, provider, and staff satisfaction. The NPT will work with participating sites to teach them how to sustain their improved antibiotic prescribing efforts after the official project has ended. The NPT will work with each Stewardship Coordinating Team and Team Leaders to create a plan on how these efforts will be sustained.


March 2017

Appendices


March 2017

Appendix A: Site Recruitment Letter – Acute Care Setting

20

AHRQ Safety Program for Improving Antibiotic Use March 2017

Operating Plan

AHRQ Safety Program for Improving Antibiotic Use in the Acute Care Setting

We hope your hospital will consider participating in the AHRQ Safety Program for Improving Antibiotic Use. The goal of this collaboration with [Insert Name of Healthcare System Here] is to assist you with optimizing antibiotic use in your facility and avoid adverse effects in your patients. The Joint Commission has an Antimicrobial Stewardship Standard effective January 2017 that requires that all hospitals have antimicrobial stewardship programs.

What is the Safety Program?

The Safety Program uses concepts from The Comprehensive Unit‐Based Safety Program (CUSP), a customizable program that promotes communication, teamwork, and leadership to support a culture of patient safety. It combines clinical best practices with improvements to patient safety culture.

What is Antibiotic Stewardship?

Antibiotic stewardship refers to coordinated efforts to ensure that antibiotics are prescribed appropriately (right antibiotic, right dose, right duration), if antibiotics are indicated. We will be teaching participants how they can all be antibiotic stewards.

Why should your unit participate?

We are requesting your participation in a 12‐month study that includes a 3‐month baseline period and a 9‐month intervention period beginning in April 2017. During this time, our research team will work closely with members of your team to understand the drivers of antibiotic prescribing, improve their knowledge of antibiotic use, and identify approaches to optimizing antibiotic use. Participation will assist with compliance with The Joint Commission Antimicrobial Stewardship Standard.

What Will be Included in the Program?

1. Access to experts in both antibiotic stewardship and improving safety culture to assist with troubleshooting and ongoing education.

2. Interactive educational modules, slide sets, and Webinars to improve the understanding of the diagnosis and treatment options of common infections.

3. User‐friendly materials to emphasize the importance of the culture of safety and ways to incorporate it into everyday practice to expand to other health care initiatives.

4. Educational materials (posters, pamphlets) for patients and family members to improve their understanding of why antibiotics are sometimes not indicated.

What Would Sites be Asked to do?

1. Identify Team Leaders to assist with overseeing work.

2. Throughout the 12‐months, The Stewardship Coordinating Team, Team Leaders, and available frontline staff will participate in bimonthly/monthly calls that will include both content and coaching. These calls will include a formal discussion of technical and/or adaptive work to improve antibiotic prescribing and will also include open dialogue about successes and failures related to improving antibiotic use.

3. During both the 3‐month base period and the 9‐month intervention period, we will use data submitted from your existing electronic health record to collect monthly data on days of antibiotic therapy per 1,000 patient‐days, rates of Clostridium difficile infection, and length of hospital stay. Once a month, The Stewardship Coordinating Team will review data on at least 10 patients receiving antibiotics to determine if antibiotic use was appropriate.

21


Operating Plan

Appendix B: Site Recruitment Letter – Long‐Term Care Setting

AHRQ Safety Program for Improving Antibiotic Use in the Long‐Term Care Setting

We hope your nursing home will consider participating in the AHRQ Safety Program for Improving Antibiotic Use. The goal of this collaboration with [Insert Name of Healthcare System Here] is to assist you with optimizing antibiotic use in your facility and avoiding adverse effects in your patients.





Why should your facility participate? We are requesting your participation in a 12‐month study that includes a 3‐month baseline period and a 9‐month intervention period beginning in April 2017. During this time, our research team will work closely with members of your nursing home to understand the drivers of antibiotic prescribing, improve their knowledge of antibiotic use, and identify approaches to optimizing antibiotic use. Participation will assist with compliance with the CMS Condition of Participation regarding antibiotic stewardship.

What Will be Included in the Program?


2. Interactive educational modules, slide sets, and Webinars to improve the understanding of the diagnosis and treatment options of common infections.

3. User‐friendly materials to emphasize the importance of the culture of safety and ways to incorporate it into every day practice to expand to other healthcare initiatives.




2. Throughout the 12‐months, Team Leaders and available frontline staff will participate in bimonthly/monthly calls that will include both content and coaching. These calls will include a formal discussion of technical or adaptive work to improve antibiotic prescribing and will also include open dialogue about successes and failures related to improving antibiotic use.

3. During both the 3‐month base period and the 9‐month intervention period, we will use data submitted from your existing electronic data to collect monthly data on days of antibiotic therapy per 1,000 patient‐days and the number of urine cultures obtained per 1,000 patient days.

23

Operating Plan

March 2017


Appendix C: Site Recruitment Letter – Ambulatory Care Setting

AHRQ Safety Program for Improving Antibiotic Use in the Ambulatory Care Setting

We hope your practice or clinic will consider participating in the AHRQ Safety Program for Improving Antibiotic Use. The goal of this collaboration with [Insert Name of Healthcare System Here] is to assist you with optimizing antibiotic use in your practice and avoid adverse effects in your patients.





Why Should Your Practice Participate? We are requesting your participation in a 12‐month study that includes a 3‐month baseline period and a 9‐month intervention period beginning in April 2017. During this time, our research team will work closely with members of your practice to understand the drivers of antibiotic prescribing, improve their knowledge of antibiotic use, and identify approaches to optimizing antibiotic use. What Will be Included in the Program?


2. Interactive educational eLearning modules, slide sets, and Webinars to improve the understanding of the diagnosis and treatment options of common infections.

3. User‐friendly materials to emphasize the importance of the culture of safety and ways to incorporate it into everyday practice to expand to other healthcare initiatives.




6. Throughout the 12‐months, Team Leaders and available frontline staff will participate in bimonthly‐monthly calls that will include both content and coaching. These calls will include a formal discussion of technical or adaptive work to improve antibiotic prescribing and will also include open dialogue about successes and failures related to improving antibiotic use.

7. During both the 3‐month base period and the 9‐month intervention period, we will use data submitted from your existing electronic medical record to collect monthly data on numbers of antibiotic prescriptions per 100 patient visits and the proportion of antibiotic use for non‐antibiotic indicated respiratory conditions.

25


Operating Plan

Appendix D: Acute Care Team Commitment Form

AHRQ Safety Program for Improving Antibiotic Use—Acute Care

Team Commitment Form Instructions Prior to committing to the AHRQ Safety Program for Improving Antibiotic Use, we strongly encourage outreach among hospital units. We ask that a senior executive as well as a physician and nursing lead be identified and that key players provide their signatures on the second page. Once reviewed, completed, and signed, this form can scanned and emailed to [email protected]. Introduction This project is funded and guided by the Agency for Healthcare Research and Quality (AHRQ). The work is being conducted by Johns Hopkins University in collaboration with NORC at the University of Chicago, and requests a 12‐month commitment to improve the outcomes for patients receiving antibiotics. A table of Potential Benefits to participation is included below. A stakeholder meeting will occur on March 21st, 2017, to introduce the project and train representatives from your site about antibiotic stewardship and improving safety culture. Onboarding/orientation webinars for the project will begin in April 2017. Baseline data collection will start in April 2017, and the intervention data collection will start in July 2017. Potential Benefits of Hospital Participation

The objective of the AHRQ Safety Project for Improving Antibiotic Use is to help sites further develop their antibiotic stewardship program and to improve the use of antibiotics in acute care, LTC and ambulatory care sites. Additionally, this project is intended to improve safety culture, enhance teamwork and communication, and improve patient, family, provider, and staff satisfaction. The NPT will work with participating sites to teach them how to sustain their improved antibiotic prescribing efforts after the official project has ended. Participation in this program assists with ensuring compliance with The Joint Commission requirements regarding antimicrobial stewardship. Site Requirements

1. Identify Team Leaders to assist with overseeing work. 2. Throughout the 12‐months, The Stewardship Coordinating Team, Team Leaders, and available frontline staff will participate in bimonthly/monthly calls that will include both content and coaching. These calls will include a formal discussion of technical or adaptive work to improve antibiotic prescribing and will also include open dialogue about successes and failures related to improving antibiotic use 3. During both the 3‐month base period and the 9‐month intervention period, we will use data submitted from your existing electronic health record to collect monthly data on days of antibiotic therapy per 1,000 patient‐days, rates of Clostridium difficile infection, and length of hospital stay. Once a month, The Stewardship Coordinating Team will review data on at least 10 patients receiving antibiotics to determine if antibiotic use was appropriate.

Data Collection Requirements Most of the requested data can be downloaded from your electronic medical records. The data you submit for this project will allow you to access reports that detail how your unit is improving in regards to the appropriate care of your patients to assist in your own quality improvement efforts. As well, your data will be aggregated, anonymized, and then shared with AHRQ and other hospitals participating in the project. You will be responsible for collecting and submitting the measures listed below: Survey Assessments

Hospital Survey on Patient Safety Culture (HSOPS) Twice

Structural Assessment Twice

Data

Days of antibiotic therapy/1,000 patient‐days Monthly

Clostridium difficile laboratory event episodes per 10,000 patient days by unit (quarterly

Quarterly

Review of at least 10 patients per month by Team Leaders and/or frontline staff with the Stewardship Coordinating Team using the Antibiotic Appropriateness Tool.

Monthly

Hospital Participation Requirements

☐ Please check the box to indicate you have read and agree to the requirements below

Action Due Date

Complete the Hospital Letter of Commitment March 15, 2017

Assemble a multidisciplinary team within your hospital unit March 15, 2017

Complete the Data Use Agreement March 15, 2017

Register your team to use the project data portal March 15, 2017

At least one team member attends stakeholder meeting March 21, 2017

Participate in educational programs including the onboarding/

orientation Webinar series, eLearning Modules and content

Webinars

Beginning April 2017

Regularly meet as a team to implement interventions and

monitor performance July 2, 2017, until end of project

Complete survey assessments and submit hospital unit data

according to the data collection schedule July 2, 2017 until end of project

We accept the invitation to participate in the AHRQ Safety Program for Improving Antibiotic Use and will comply with the requirements stated above.

Hospital Executive Signature Date

Print Name

Physician Lead Signature Date

Print Name

Nursing Lead Signature Date

Print Name

Johns Hopkins IRB # IRB00112077

Sara Cosgrove, M.D., M.S., and Pranita Tamma, M.D., M.H.S.

Questions? Email: [email protected]

Commitment

29

March 2017AHRQ Safety Program for Improving Antibiotic Use

Operating Plan

Appendix E: Long‐Term Care Team Commitment Form

AHRQ Safety Program for Improving Antibiotic Use—Long‐Term Care

Team Commitment Form Instructions Prior to committing to the AHRQ Safety Program for Improving Antibiotic Use, we strongly encourage outreach among long‐term care (LTC) units. We ask that a senior executive as well as a physician and nursing lead be identified and that key players provide their signatures on the second page. Once reviewed, completed, and signed, this form can be scanned and emailed to [email protected] Introduction This project is funded and guided by the Agency for Healthcare Research and Quality (AHRQ). The work is being conducted by Johns Hopkins University in collaboration with NORC at the University of Chicago, and asks for a 12‐month commitment to improve the outcomes for patients receiving antibiotics. A stakeholder meeting will occur on March 21st, 2017, to introduce the project and train representatives from your site about antibiotic stewardship and improving safety culture. Onboarding/orientation Webinars for the project will begin in April 2017. Baseline data collection will start in April 2017, and intervention data collection will start in July 2017. Potential Benefits of Facility Participation

The objective of the AHRQ Safety Project for Improving Antibiotic Use is to help sites further develop their antibiotic stewardship program and to improve the use of antibiotics at acute care, LTC and ambulatory care sites. Additionally, this project is intended to improve safety culture, enhance teamwork and communication, and improve patient, family, provider, and staff satisfaction. The NPT will work with participating sites to teach them how to sustain their improved antibiotic prescribing efforts after the official project has ended. Participation in this program with ensure compliance with The Centers for Medicare and Medicaid Condition of Participation regarding antimicrobial stewardship. Site Requirements


2. Throughout the 12‐months, Team Leaders and available frontline staff will participate in bimonthly‐monthly calls that will include both content and coaching. These calls will include a formal discussion of technical or adaptive work to improve antibiotic prescribing and will also include open dialogue about successes and failures related to improving antibiotic use.

3. During both the 3‐month base period and the 9‐month intervention period, we will use data submitted from your existing electronic data to collect monthly data on days of antibiotic therapy per 1,000 patient‐days and the number of urine cultures obtained per 1,000 patient days.

Data Collection Requirements The data you submit for this project will allow you to access real‐time reports that detail how your unit is improving in regards to the appropriate care of your patients to support your own quality improvement efforts. As well, your data will be aggregated, anonymized, and then shared with AHRQ and other LTC facilities participating in the project. You will be responsible for collecting and submitting the measures listed below: Survey Assessments

Nursing Home Survey on Patient Safety (NHSOPS) Twice


Data

Days of antibiotic therapy/1,000 patient‐days Monthly

Proportion of urine cultures obtained/1,000 patient‐days Monthly

Long‐Term Care Participation Requirements


Action Due Date

Complete the LTC Letter of Commitment March 15, 2017

Assemble a multidisciplinary team within the LTC unit March 21, 2017





orientation Webinar series, eLearning modules and content Webinars Beginning April 2017

Regularly meet as a team to implement interventions and monitor

performance

July 2, 2017, until end of

project

Complete survey assessments and submit LTC unit data according to

the data collection schedule


project


Facility Executive Signature Date

Print Name


Print Name

Nursing Lead Signature Date

Print Name

Johns Hopkins IRB # IRB00112077 Sara Cosgrove, M.D., M.S., and Pranita Tamma, M.D., M.H.S.


Commitment

33

Operating Plan


Appendix F: Ambulatory Care Team Commitment Form

AHRQ Safety Program for Improving Antibiotic Use—Ambulatory Care Team Commitment Form

Instructions Prior to committing to the AHRQ Safety Program for Improving Antibiotic Use, we strongly encourage outreach among ambulatory care sites. We ask that a senior executive as well as a physician lead be identified and that key players provide their signatures on the second page. Once reviewed, completed, and signed, this form can be scanned and emailed to [email protected]. Introduction This project is funded and guided by the Agency for Healthcare Research and Quality (AHRQ). The work is being conducted by Johns Hopkins University in collaboration with NORC at the University of Chicago, and asks for a twelve‐month commitment to improve the outcomes for patients receiving antibiotics. A stakeholder meeting will occur on March 21, 2017, to introduce the project and train representatives from your site about antibiotic stewardship and improving safety culture. Onboarding/orientation Webinars for the project will begin in April 2017. Baseline data collection will start in April, 2017, and the intervention data collection will start in July 2017. Potential Benefits of Ambulatory Care Facility Participation The objective of the AHRQ Safety Program for Improving Antibiotic Use is to help sites further develop their antibiotic stewardship program and to improve the use of antibiotics at acute care, LTC and ambulatory care sites. Additionally, this project is intended to improve safety culture, enhance teamwork and communication, and improve patient, family, provider and staff satisfaction. The NPT will work with participating sites to teach them how to sustain their improved antibiotic prescribing efforts after the official project has ended. Participation in this program will foster compliance with The Centers for Disease Control and Prevention Core Elements of Outpatient Antibiotic Stewardship. Site Requirements


2. Throughout the 12‐months, Team Leaders and available staff will participate in monthly call that will include both content and coaching. The calls will include a formal discussion of technical or adaptive work to improve antibiotic prescribing and will also include open dialogue about successes and failures related to improving antibiotic use.

3. During both the 3‐month base period and the 9‐month intervention period, we will use data submitted from your existing electronic medical records to collect monthly data on antibiotic therapy per 100 patient visits and the proportion of antibiotic prescriptions associated non‐antibiotic‐appropriate respiratory conditions, by ICD‐10 code (non‐specific URIs, acute bronchitis, influenza).

Data Collection Requirements In addition to implementing the CUSP model, your facility will be responsible for timely and accurate data collection and submission. Most of this data can be downloaded from your electronic medical records. The data you submit for this project will allow you to access real‐time reports that detail how your ambulatory care units are improving in regards to the appropriate care of your patients in support of your own quality improvement efforts. As well, your data will be aggregated, anonymized, and shared with AHRQ and other ambulatory care facilities participating in the project. You will be responsible for collecting and submitting the measures listed below:

Survey Assessments

Survey on Patient Safety (SOPS) Twice


Implementation Assessment Twice

Data

Antibiotic therapy per 100 patient visits Monthly

Diagnosis‐specific antibiotic prescribing rates Monthly

Ambulatory Care Facility Participation Requirements


Action Due Date

Complete the Ambulatory Facility Letter of Commitment March 1, 2017

Assemble a multidisciplinary team March 1, 2017





orientation Webinar series, eLearning Modules and content Webinars

Beginning April 2017

Regularly meet as a team to implement interventions and monitor

performance


project

Complete survey assessments and submit facility data according to

the data collection schedule


project


Facility Executive Signature Date

Print Name


Print Name

Johns Hopkins IRB # IRB00112077 Sara Cosgrove M.D., M.S., and Pranita Tamma, M.D., M.H.S.


Commitment

37


Operating Plan

Appendix G: Data Use Agreement

Data Use Agreement 38 of 64

Data Use Agreement Between

National Opinion Research Center (NORC) And

NAME This Data Use Agreement (“Agreement”) is made and entered into as of DATE (the “Effective Date”) by and between NAME (“Data Provider”), and NORC (“DATA RECIPIENT”) for purposes of establishing a formal data access and data use relationship between Data Provider and DATA RECIPIENT, to enable DATA RECIPIENT to fulfill its responsibility as data collection and analysis lead for the project entitled; AHRQ Safety Program for Improving Antibiotic Use.

WITNESSETH: WHEREAS, Data Provider may disclose or make available to DATA RECIPIENT, and DATA RECIPIENT may use, disclose, receive, transmit, maintain or create from, certain information in conjunction with the work performed under AHRQ Safety Program for Improving Antibiotic Use; and WHEREAS, the purpose of this Agreement is to satisfy the data sharing obligations of the parties and to ensure the integrity and confidentiality of certain information (“Data Set”) disclosed or make available to DATA RECIPIENT and certain information that DATA RECIPIENT uses, discloses, receives, transmits, maintains or creates, from Data Provider. NOW, THEREFORE, in consideration of the foregoing recitals and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows:

1. SCOPE AND PURPOSE

A. This Agreement sets forth the terms and conditions pursuant to which Data Provider will disclose the Data Set to DATA RECIPIENT.

B. DATA RECIPIENT will only use the Data Set for the limited purposes necessary to conduct the

activities described in Attachment A.

2. OBLIGATIONS AND ACTIVITIES OF DATA RECIPIENT

A. DATA RECIPIENT agrees to protect the Data Set to prevent use or disclosure of the Data Set

other than as provided for by this Agreement. The Data Set shall be stored in an area that is physically safe from access from unauthorized persons at all times. The Data Set shall be protected electronically to prevent unauthorized access by computer, remote access, or any other means. DATA RECIPIENT expressly agrees that the Data Set will not be accessed, tested, maintained, backed up, or stored outside of the United States.

B. DATA RECIPIENT agrees to not use or disclose the Data Set for any purpose other than as described in this Agreement or as required by law. DATA RECIPIENT shall not disclose the Data Set to any third party without specific written authorization from DATA PROVIDER. This agreement constitutes written authorization for DATA RECIPIENT to share the Data Set with the following third parties:

i. Johns Hopkins University (JHU) ii. PARTY NAME HERE iii. PARTY NAME HERE


C. DATA RECIPIENT shall assure that all persons who have access to the Data Set shall be fully apprised as to the confidential nature of the Data Set, the safeguards required to protect the information, and the applicable civil and criminal sanctions and penalties associated with any intentional or non-intentional disclosure. No third party shall receive any information without a written agreement with DATA RECIPIENT incorporating these assurances.

D. DATA RECIPIENT agrees to use appropriate safeguards to prevent use or disclosure of the

Data Set other than as provided for by this Agreement. DATA RECIPIENT specifically agrees to comply with state and federal confidentiality and information disclosure laws, rules, and regulations applicable to programs under with this Agreement.

E. DATA RECIPIENT agrees to report in writing to Data Provider any use or disclosure of any

portion of the Data Set not provided for by this Agreement of which it becomes aware, including without limitation, any disclosure to an unauthorized subcontractor or any other individual or entity not approved to receive the Data Set, within five (5) days of its discovery.

F. DATA RECIPIENT agrees that it shall obtain and maintain, for the term of this Agreement, a

written agreement with each contractor or with any agent, including a subcontractor, to whom it provides any portion of the Data Set holding them to the same restrictions and conditions that apply through this Agreement to DATA RECIPIENT with respect to such information. Further, upon request, DATA RECIPIENT will provide copies of such agreements to Data Provider.

G. DATA RECIPIENT agrees to notify Data Provider in writing within five (5) business days of

DATA RECIPIENT’s receipt of any request or subpoena for any portion of the Data Set or any information related to this Agreement. To the extent that Data Provider decides to assume responsibility for challenging the validity of such request, DATA RECIPIENT will cooperate fully with Data Provider in any such challenge.

H. DATA RECIPIENT shall permit onsite inspection by Data Provider and by agencies of the

United States government to ensure compliance with this Agreement. I. DATA RECIPIENT shall maintain encryption standards found in NIST Special Publication 800-

53 while the data is in a portable format (e.g. tape, laptop, flash/USB drive). J. The express terms and conditions of this Article shall be included in all subcontracts executed

by DATA RECIPIENT for any and all work under this Agreement.

3. TERM AND TERMINATION

A. The provisions of this Agreement shall be effective as of the Effective Date and shall terminate when all of the Data Set provided by Data Provider to DATA RECIPIENT is destroyed or returned to Data Provider, or, if it is infeasible to return or destroy the Data Set, protections are extended to such information, in accordance with the termination provisions in this Section.

B. The confidentiality provisions of this Agreement shall survive the termination of this Agreement.

C. Upon Data Provider’s knowledge of a breach by DATA RECIPIENT, Data Provider shall:

i. Provide DATA RECIPIENT with written notice of the breach and an opportunity to cure the breach within ten (10) days of receipt of such notice. If DATA RECIPIENT fails to cure the breach within the notice period, Data Provider may immediately terminate this Agreement; or

ii. Immediately terminate this Agreement (without opportunity to cure) if Data Provider determines, in its sole discretion, that DATA RECIPIENT has breached a material term of this Agreement.


4. MISCELLANEOUS

A. The respective rights and obligations of DATA RECIPIENT under Article 2 of this Agreement shall survive termination of this Agreement.

B. There are no intended third party beneficiaries to this Agreement. Without in any way limiting

the foregoing, it is the parties’ specific intent that nothing contained in this Agreement gives rise to any right or cause of action, contractual or otherwise, in or on behalf of the individuals whose information is used or disclosed pursuant to this Agreement.

C. No provision of this Agreement may be waived or modified except by an agreement in writing

signed by the waiving party. A waiver of any term or provision shall not be construed as a waiver of any other term or provision.

D. The persons signing below have the right and authority to execute this Agreement and no

further approvals are necessary to create a binding agreement.

E. In the event of any conflict between the terms and conditions stated within this Agreement and those contained within any other agreement or understanding between the parties, written, oral or implied, the terms of this Agreement shall govern. Without limiting the foregoing, no provision of any other agreement or understanding between the parties limiting the liability of DATA RECIPIENT to Data Provider shall apply to the breach of any covenant in this Agreement by DATA RECIPIENT.


IN WITNESS WHEREOF, the parties have executed this Agreement effective upon the Effective Date set forth above.

APPROVED BY:

NORC NAME (Data Provider)

Signature: Signature:

Print Name: Print Name:

Title: Title:

Date: Date:


ATTACHMENT A

Scope: NORC is the data collection sub-contractor for the AHRQ Safety Program for Improving Antibiotic Use. The goals of the project are to integrate the appropriate technical and adaptive interventions to improve antibiotic decision-making in acute care, long-term care, and ambulatory care settings. To conduct an evaluation of the program, NORC is requesting that NAME complete the following data collection forms and surveys on the AHRQ Safety Program for Improving Antibiotic Use online data collection platform. Each facility participating in the project will access the data collection platform by signing in with a unique username and password combination assigned by the NORC site administrator. The data entered by NAME will be electronically submitted to NORC and stored on NORC’s secure servers. The online data collection platform adheres to the NIST security standards and is SSL certificate enabled to ensure security of the data being transmitted. 1) Structural Assessments: The structural assessment will be administered to the AHRQ Safety Program

Antibiotic Stewardship physician, pharmacist lead, or other individual designated by NAME. The assessment will be administered at baseline (pre-intervention), at the end of the intervention, and one year from the end of the intervention. The data will collect basic information about NAME’s institution or unit as well as their experience of team-based safety program and activities related to improving antibiotic use.

2) Team Antibiotic Review Form: The Stewardship Team at NAME will complete a monthly Team Antibiotic Review Form for patients who are prescribed antibiotics during the intervention period (at least 10 cases per month).

3) The AHRQ Surveys on Patient Safety Culture: The surveys will be administered to all AHRQ Safety Program for Improving Antibiotic Use participating staff at NAME at the baseline (pre-intervention) and end of the intervention. The surveys have been adapted for the three types of health care settings. The surveys collect information on patient safety issues, medical errors, and event reporting.

a. The Hospital Survey on Patient Safety Culture (HSOPS) will be utilized to evaluate safety culture for acute care hospitals.

b. The Nursing Home Survey on Patient Safety Culture (NHSOPS) will be administered in long term care.

c. The Medical Office Survey on Patient Safety Culture (MOSOPS) will be administered in ambulatory care centers.

Electronic Health Record (EHR) data: Each month (or quarter) between baseline (pre-intervention) and the end of the intervention, the onsite data coordinator or other individual designated by NAME will extract clinical measures data from NAME’s EHR system. The clinical measures data will be used to help understand how the AHRQ Safety Program for Improving Antibiotic Use program may be impacting the antibiotic use and related outcomes in the unit.

43

Operating Plan


Appendix H: Acute Care Call Schedule

44

Operating Plan



Acute Care eLearning Modules and Schedule of Webinars Date/Time Title and Objectives Target

Audience April 11th, 2017 2:00-3:00 ET

Onboarding Call #1: By the end of this module, participants will be able to:

- Understand the goals of the AHRQ Safety Program for Improving Antibiotic Use

- Understand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the current program

- Understand the timeline of the AHRQ Safety Program - Understand the technical and adaptive components that will be

included in the educational toolkit

Antibiotic Stewardship Team (optional: unit leaders)

April 25th, 2017 2:00-3:00 ET

Onboarding Call #2: By the end of this module, participants will be able to:

- Apply the Four Moments of Antibiotic Decision-Making - Understand how the CUSP approach can improve safety culture - Understand how to access data and upload data on the AHRQ

Safety Program website - Understand how to use the “Appropriateness Tool” to review

antibiotic use with frontline staff

Antibiotic Stewardship Team (optional: unit leaders)

May 16th, 2017 2:00-3:00 ET

Antibiotic Stewardship Program (ASP) Development: By the end of this module, participants will be able to:

- Understand the key personnel necessary for developing an ASP - Discuss the pros and cons of the various interventions

commonly used by ASPs - Discuss the evaluation approaches used by ASPs - Understand which senior executives to approach for antibiotic

improvement efforts - Understand how to work with a senior executive to develop a

shared understanding of local defects

Antibiotic Stewardship Team

May 30th, 2017 2:00 – 3:00 ET

Improving Antibiotic Use is a Patient Safety Issue (CUSP 1) By the end of this module, participants will be able to:

- Discuss the potential harm associated with antibiotic use - Understand that patient harm is largely preventable - Understand that change efforts often require a focus on

systems, not individuals - Recognize the principles of sage design

Antibiotic Stewardship Team, unit leaders, and any available frontline Staff

45

Operating Plan


- Understand the importance of diverse input to prevent harm

June 6th, 2017 2:00-3:00 ET

Behavior Change Theory for Antibiotic Stewardship Leaders: By the end of this module, participants will be able to:

- Understand what motivates healthcare providers to prescribe antibiotics

- Understand basic theories regarding implementation science and organizational change to implement antibiotic stewardship interventions and to change prescribing habits

- Understand successful antibiotic stewardship behavior interventions in the acute care setting

Antibiotic Stewardship Team

June 27th, 2017 2:00 – 3:00 ET

Identifying Targets for Improving Antibiotic Use (CUSP 2) By the end of this module, participants will be able to:

- Understand how to identify patient safety risks in their clinical areas

- Understand how to be proactive in asking staff how the next patient will be harmed

- Understand how to leverage frontline wisdom to guide safety improvement efforts

Antibiotic Stewardship Team, unit leaders, and any available frontline staff

July 11th, 2017 2:00 – 3:00 ET

Improving Antibiotic Use by Learning from Defects (CUSP 3) By the end of this module, participants will be able to:

- Understand how to identify the relevant system factors related to defects in the system

- Develop interventions to reduce future risk - Ensure that interventions are effectively addressing defects

related to antibiotic prescribing


July 25th, 2017 2:00 – 3:00 ET

Improving Teamwork and Communication Around Antibiotic Prescribing (CUSP 4) By the end of this module, participants will be able to:

- Understand the importance of seeking input from all team members when making antibiotic prescribing decisions

- Understand how to use available AHRQ Safety Tools to improve communication related to The Four Moments of Antibiotic Decision Making

- Understand how to effectively communicate the potential harm antibiotics can cause with patients and other healthcare providers

Antibiotic Stewardship Team, unit leaders, and any available Frontline staff

August 15th, 2017 2:00 – 3:00 ET

Team Approach to Stewardship of Asymptomatic Bacteriuria (ASB) and Urinary Tract Infections (UTIs): By the end of this module, participants will be able to:

Antibiotic Stewardship Team, unit leaders, and any

46

Operating Plan


- Understand how to distinguish asymptomatic bacteriuria, cystitis, and pyelonephritis

- Develop empiric treatment recommendations for UTIs that are institution specific and minimize adverse events

- Discuss opportunities for de-escalation of antibiotic therapy for UTIs after additional clinical data are available

- Discuss reasonable durations of antibiotic therapy for UTIs - Discuss challenges and ambiguities in developing and

executing a standardized approach to management of ASB and UTI

available frontline Staff

September 19th, 2017 2:00 – 3:00 ET

Team Approach to Stewardship of Community-Acquired Lower Respiratory Tract Conditions: By the end of this module, participants will be able to:

- Understand the approach to diagnosing community-acquired pneumonia (CAP), chronic obstructive pulmonary disease (COPD) exacerbation, and aspiration pneumonia

- Develop empiric treatment recommendations for CAP, COPD exacerbation and aspiration pneumonia that are institution specific and minimize adverse events

- Discuss opportunities for de-escalation of antibiotic therapy for CAP after additional clinical data are available

- Discuss reasonable durations of antibiotic therapy for CAP, COPD exacerbation, and aspiration pneumonia

- Discuss challenges and ambiguities in developing and executing a standardized approach to management of CAP, COPD exacerbation, and aspiration pneumonia

Antibiotic Stewardship Team, unit leaders, and any available Frontline Staff

October 10th, 2017 2:00 – 3:00 ET

Team Approach to Stewardship of Healthcare-Associated Pneumonia (HCAP) and Ventilator-Associated Pneumonia (VAP): By the end of this module, participants will be able to:

- Understand the approach to diagnosing HCAP and VAP - Develop empiric treatment recommendations for HCAP and

VAP that are institution specific and minimize adverse events - Discuss opportunities for de-escalation of antibiotic therapy for

HCAP and VAP after additional clinical data are available - Discuss reasonable durations of antibiotic therapy for HCAP

and VAP - Discuss challenges and ambiguities in developing and

executing a standardized approach to management of HCAP and VAP


November 14th, 2017 2:00 – 3:00 ET

Team Approach to Stewardship of Skin and Soft Tissue Infections (SSTIs): By the end of this module, participants will be able to:

- Understand the approach to diagnosing SSTIs

Antibiotic Stewardship Team, unit leaders, and any available

47

Operating Plan


- Develop empiric treatment options for SSTIs that are institution specific and minimize adverse events

- Discuss opportunities for de-escalation of antibiotic therapy for SSTIs after additional clinical data are available

- Discuss reasonable durations of antibiotic therapy for SSTIs - Discuss challenges and ambiguities in developing and

executing a standardized approach to management of SSTIs

frontline Staff

December 19th, 2017 2:00 – 3:00 ET

Team Approach to Stewardship of Intra-Abdominal Infections (IAI): By the end of this module, participants will be able to:

- Understand the approach to diagnosing IAIs - Develop empiric treatment options for IAIs that are institution

specific and minimize adverse events - Discuss opportunities for de-escalation of antibiotic therapy for

IAIs after additional clinical data are available - Discuss reasonable durations of antibiotic therapy for IAIs - Discuss challenges and ambiguities in developing and

executing a standardized approach to management of IAIs


January 16th, 2018 2:00 – 3:00 ET

Team Approach to Prevention, Diagnosis, and Management of Clostridium difficile Infections (CDI): By the end of this module, participants will be able to:

- Understand the risk factors associated with CDI - Understand when CDI testing is warranted - Understand how to distinguish CDI colonization and infection - Discuss stewardship interventions to reduce CDI - Understand treatment approaches for CDI


February 13th, 2018 2:00 – 3:00 ET

Coaching Call About Team-Based Stewardship Implementation Note: There will not be an eLearning module associated with this webinar By the end of this module, participants will be able to

- Discuss barriers to and potential mitigation strategies for implementation of team-based stewardship interventions


March 20th, 2018 2:00 – 3:00 ET

Sustaining Antibiotic Stewardship Efforts: By the end of this module, participants will be able to:

- Understand the need for stewardship interventions to be sustained to have a continued effect

- Discuss approaches for identifying new stewardship targets - Discuss personnel and resources necessary for a stewardship

program to successfully be sustained


48

Operating Plan


Appendix I: Long‐Term Care Call Schedule

49

Operating Plan



Long-Term Care eLearning Modules and Schedule of Webinars

Month Available

Title and Objectives Target Audience

April 3rd, 2017

1:00-2:00 ET

Onboarding Call #1:

By the end of this module, participants will be able to:


- Understand The Centers of Medicare and Medicaid requirements for participation related to Antibiotic Stewardship in the LTC setting

- Understand the timeline of the AHRQ Safety Program

Master Trainers

(Physician lead, Director of Nursing, and [if available] pharmacist lead)

April 17th, 2017

1:00-2:00 ET

Onboarding Call #2:


- Understand how the CUSP approach can improve safety culture

- Understand the technical and adaptive components that will be included in the educational toolkit

- Understand how to access data and upload data on the AHRQ Safety Program website

Master Trainers

May 1st, 2017

1:00-2:00 ET

Antibiotic Stewardship Program (ASP) Development:


- Understand the key personnel necessary for developing an ASP

- Discuss the pros and cons of the various interventions commonly used by ASPs in the LTC setting

- Discuss the evaluation approaches used by ASPs

Master Trainers

May 22nd, 2017

1:00-1:30 ET

CUSP #1: The Science of Safety:



systems, not individuals - Recognize the principles of sage design

Master Trainers and Frontline Staff

50

Operating Plan


- Understand the importance of diverse input to prevent harm

June 5th, 2017

1:00-1:30 ET

CUSP #2: Identifying Defects:






June 19th, 2017

1:00-1:30 ET

CUSP #3: Partnering with a Senior Executive:


- Understand which executives to approach for antibiotic improvement efforts

- Understand how to work with an executive to develop a shared understanding of local defects

- Understand how to develop shared accountability for implementing antibiotic improvement efforts


July 3rd, 2017

1:00-1:30 ET

CUSP #4: Learning from Defects:






July 17th, 2017

1:00-1:30 ET

CUSP #5: Improving Teamwork and Communication:



- Understand how to use available AHRQ Safety Tools to improve communication between staff members

- Understand how to effectively communicate the potential harm antibiotics can cause with patients


August 7th, 2017

1:00-1:30 ET

Appropriate Collection of Urine Specimens


- Understand the importance of obtaining a urinalysis and urine culture only when a resident has clinical signs and symptoms consistent with a urinary tract infection (UTI)


51

Operating Plan


- Understand how to obtain a urine culture to minimize the risk of contamination

- Understand procedures for collecting urine samples from residents with and without urinary catheters

September 11th, 2017

1:00-1:30 ET

Determining if a Resident has a Urinary Tract Infection


- Understand how to interpret the results of a urinalysis and urine culture

- Understand how to determine if a resident has asymptomatic bacteriuria vs. cystitis vs. pyelonephritis

- Understand alternate diagnoses that can result in change in mental status


October 2nd, 2017

1:00-1:30 ET

Management of Urinary Tract Infections


- Describe empiric treatment options for cystitis vs. pyelonephritis

- Discuss opportunities for de-escalation of antibiotic therapy for UTIs after additional clinical data are available

- Discuss reasonable durations of antibiotic therapy for UTIs


November 6th, 2017

1:00-1:30 ET

Distinguishing Bacterial versus Nonbacterial Causes of Lower Respiratory Tract Conditions


- Understand how to distinguish non-antibiotic respiratory conditions) from antibiotic appropriate respiratory conditions

- Understand when patients with aspiration episodes are likely to and to not benefit from antibiotic therapy

- Understand when patients with asthma exacerbations are likely to and to not benefit from antibiotic therapy


December 4th, 2017

1:00-1:30 ET

Management of Lower Respiratory Tract Conditions


- Understand the approach to healthcare-associated pneumonia (HCAP)

- Describe empiric treatment options for HCAP - Discuss opportunities for de-escalation of antibiotic therapy for

HCAP after additional clinical data are available - Discuss reasonable durations of antibiotic therapy for HCAP - Describe management approaches for chronic obstructive

pulmonary disease


52

Operating Plan


January 8th, 2018

1:00-1:30 ET

How Should I Discuss Infection Concerns about Residents to Antibiotic Prescribers?


- Understand the different kinds of briefings and when to use an Situation, Background, Assessment and Recommendations

- (SBAR) briefing - Describe the components of SBAR - Implement SBAR to improve communication between

providers and nursing staff - Recognize that SBAR can support the role of nurses and

nurses as advocates for antibiotic stewardship


February 5th, 2018

1:00-1:30 ET

How do I Communicate with Family Members that a Resident Will Likely not Benefit from Antibiotic Therapy?


- Discuss the potential harms caused by antibiotics with family members

- Discuss end of life care as it relates to antibiotic use - Discuss approaches to providing supportive care to residents

who are uncomfortable, other than prescribing antibiotics


March 5th, 2018

1:00-2:00 ET

Sustaining Antibiotic Stewardship Efforts:



- Discuss approaches for identifying new stewardship targets - Discuss personnel and resources necessary for a stewardship

program to successfully be sustained


53

Operating Plan


Appendix J: Ambulatory Care Call Schedule

54

Operating Plan



Ambulatory Care eLearning Modules and Schedule of Webinars (Updates Coming)

Month Available

Title and Objectives Target Audience

April 25th, 2017

12:00-1:00 ET

Onboarding Call #1:



- Discuss The Centers for Disease Control and Prevention Core Elements of Outpatient Antibiotic Stewardship

- Understand the timeline of the AHRQ Safety Program

Master Trainers

(Physician lead,

[and if available] nurse lead and pharmacist lead)

May 23rd, 2017

12:00-1:00 ET

Onboarding Call #2:


- Understand how the CUSP approach can improve safety culture

- Understand the technical and adaptive components that will be included in the educational toolkit

- Understand how to access data and upload data on the AHRQ Safety Program website

Master Trainers

June 27th, 2017

12:00-12:30 ET

CUSP #1: The Science of Safety:



systems, not individuals - Recognize the principles of sage design - Understand the importance of diverse input to prevent harm


July 25th, 2017

12:00-12:30 ET

CUSP #2: Identifying Defects:






55

Operating Plan


August 22nd, 2017

12:00-12:30 ET

CUSP #3: Partnering with a Senior Executive:


- Understand which executives to approach for antibiotic improvement efforts

- Understand how to work with an executive to develop a shared understanding of local defects

- Understand how to develop shared accountability for implementing antibiotic improvement efforts


September 26th, 2017

12:00-12:30 ET

CUSP #4: Learning from Defects:






October 24th, 2017

12:00-12:30 ET

CUSP #5: Improving Teamwork and Communication:



- Understand how to use available AHRQ Safety Tools to improve communication between staff members

- Understand how to effectively communicate the potential harm antibiotics can cause with patients


November 28th, 2017

12:00-12:30 ET

Diagnosis Sinusitis and Pharyngitis


- Discuss when antibiotics may be indicated for sinusitis - Discuss when antibiotics may be indicated for pharyngitis - Discuss treatment options for sinusitis, when antibiotics may

be indicated - Discuss the treatment approach for pharyngitis, when

antibiotics are indicated


December 19th, 2017

12:00-12:30 ET

Acute Bronchitis and Viral Respiratory Infections (Including Influenza)


- Understand how to interpret the results of a urinalysis and urine culture

- Understand how to determine if a resident has asymptomatic bacteriuria vs. cystitis vs. pyelonephritis


56

Operating Plan


- Understand alternate diagnoses that can result in change in mental status

January 23rd, 2018

12:00-12:30 ET

The Diagnosis and Management of Community-Acquired Pneumonia:


- Understand the approach to diagnosing community-acquired pneumonia (CAP)

- Describe outpatient treatment options for CAP - Describe treatment options for chronic obstructive

pulmonary disease exacerbations


February 27th, 2018

12:00-12:30 ET

How do I Effectively Communicate with Patients when Antibiotics are Not Necessary?


- Discuss the potential harms caused by antibiotics with patients

- Discuss approaches to providing supportive care to patients who are uncomfortable, other than prescribing antibiotics


March 27th, 2018

12:00-1:00 ET

Sustaining Antibiotic Stewardship Efforts:



- Discuss approaches for identifying new stewardship targets in the outpatient setting

- Discuss personnel and resources necessary for a stewardship program to successfully be sustained


•

57

Operating Plan


Appendix K: Acute Care Team Roster

58

Operating Plan


Acute Care Team Roster

Team Position Role Description

Medical Director …

Nurse Leader …

Pharmacist …

Roster

Hospital Name

Unit Name

Medical Director

First Name

Last Name

Title

Credentials

E‐Mail Address

Nurse Leader

First Name

Last Name

Title

Credentials

E‐Mail Address

Pharmacist

First Name

Last Name

Title

Credentials

E‐Mail Address

59

Operating Plan


Appendix L: Long‐Term Care Team Roster

60

Operating Plan


Long‐Term Care Team Roster


Medical Director …

Nurse Leader …

Roster

Facility Name

Unit Name (if needed)

Medical Director

First Name

Last Name

Title

Credentials

E‐Mail Address

Nurse Leader

First Name

Last Name

Title

Credentials

E‐Mail Address

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Operating Plan


Appendix M: Ambulatory Care Team Roster

62

Operating Plan


Ambulatory Care Team Roster


Physician …

Nurse …

Roster

Facility Name

Practice Name (if needed)

Physician

First Name

Last Name

Title

Credentials

E‐Mail Address

Nurse

First Name

Last Name

Title

Credentials

E‐Mail Address

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Operating Plan


Appendix N: Timeline for All Site Types

ahrq for improving operating plan - liberty safety program for improving antibiotic use operating...

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