Tool: SSA - AHRQ Safety Program for Improving Antibiotic Use



AHRQ Safety Program for Improving Antibiotic Use Operating PlanMarch 2nd, 2017Prepared for:Agency for Healthcare Research and QualityU.S. Department of Health and Human ServicesContract Number: HHSP233201500020I_HHSP23337003TJohns Hopkins Medicine IRB #s IRB00112077, IRB00128248JHU: Sara Cosgrove, MD, MS and Pranita Tamma, MD, MHSNORC: Prashila Dullabh, MDPrepared by:Johns Hopkins University and NORCTable of Contents TOC \o "1-3" \h \z \u Welcome PAGEREF _Toc476147351 \h 4Overview of Project PAGEREF _Toc476147352 \h 4Target Audience PAGEREF _Toc476147353 \h 4Operating Plan Updates PAGEREF _Toc476147354 \h 4Key Terms PAGEREF _Toc476147355 \h 5Phase 1: Planning PAGEREF _Toc476147356 \h 6At A Glance PAGEREF _Toc476147357 \h 6Description PAGEREF _Toc476147358 \h 6Phase 1: Planning Deliverables PAGEREF _Toc476147359 \h 9Phase 1: Planning Activities PAGEREF _Toc476147360 \h 10Phase 2: Onboarding (April 2017) PAGEREF _Toc476147361 \h 11At a Glance PAGEREF _Toc476147362 \h 11Description PAGEREF _Toc476147363 \h 11Phase 2: Onboarding Deliverables PAGEREF _Toc476147364 \h 14Phase 3: Implementation (July 2017 – March 2018) PAGEREF _Toc476147365 \h 15At a Glance PAGEREF _Toc476147366 \h 15Description PAGEREF _Toc476147367 \h 15Phase 3: Implementation Activities PAGEREF _Toc476147368 \h 16Phase 4: Sustainability (February 2018 and on) PAGEREF _Toc476147369 \h 17Appendices PAGEREF _Toc476147370 \h 18Appendix A: Site Recruitment Letter – Acute Care Setting PAGEREF _Toc476147371 \h 19Appendix B: Site Recruitment Letter – Long-Term Care Setting PAGEREF _Toc476147372 \h 21Appendix C: Site Recruitment Letter – Ambulatory Care Setting PAGEREF _Toc476147373 \h 23Appendix D: Acute Care Team Commitment Form PAGEREF _Toc476147374 \h 25Appendix E: Long-Term Care Team Commitment Form PAGEREF _Toc476147377 \h 29Appendix F: Ambulatory Care Team Commitment Form PAGEREF _Toc476147380 \h 33Appendix G: Data Use Agreement PAGEREF _Toc476147383 \h 37Appendix H: Acute Care Call Schedule PAGEREF _Toc476147384 \h 43Appendix I: Long-Term Care Call Schedule PAGEREF _Toc476147386 \h 48Appendix J: Ambulatory Care Call Schedule PAGEREF _Toc476147387 \h 53Appendix K: Acute Care Team Roster PAGEREF _Toc476147388 \h 57Appendix L: Long-Term Care Team Roster PAGEREF _Toc476147398 \h 59Appendix M: Ambulatory Care Team Roster PAGEREF _Toc476147406 \h 61Appendix N: Timeline for All Site Types PAGEREF _Toc476147414 \h 63WelcomeWelcome to the AHRQ Safety Program for Improving Antibiotic Use. We are excited to have your group onboard and participating in this project.Overview of ProjectThis 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 AudienceCoordinating entities include: Carolinas Healthcare System, Geisinger Health System and Johns Hopkins Health System.Operating Plan UpdatesThis 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 antibioticsafety@jhmi.edu. Key TermsAHRQAgency for Healthcare Research and QualitySafety ProgramAHRQ Safety Program for Improving Antibiotic UseCUSPComprehensive Unit-Based Safety ProgramDUAData Use AgreementHIINHealth Improvement Innovation NetworkHSOPSHospital Survey on Patient SafetyIRBInstitutional Review BoardJHUJohns Hopkins UniversityMOSOPSMedical Office Survey on Patient SafetyNHSOPSNursing Home Survey on Patient SafetyNORCNORC (at the University of Chicago)NPTNational Project Team (JHU and NORC)QIN/QIOsQuality Improvement Networks/Quality Improvement OrganizationsPhase 1: PlanningAt A GlanceReceive and review the Operating PlanReceive the recruitment packageStart recruiting sites (acute care hospitals and units, long-term care facilities and ambulatory care facilities)Review and complete the Coordinating Entity Commitment LetterEmail sites all required materials, and collect completed documents before project launchFacility Letter of CommitmentFacility Data Use AgreementCollect facility and site information for registration, as appropriateReview Implementation GuideAttend Stakeholder MeetingDescriptionOperating PlanThe 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 PackageTo 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 SitesSite 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 ApprovalThe 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 RegistrationInformation 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 GuideThe 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 MeetingThis 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.Data Portal Workshop and Project WebsiteThe homepage for the project is accessible with the following URL: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.Phase 1: Planning DeliverablesDate ProvidedDeliverable DescriptionAppendixProvided byTimeline/DetailsFebruary 2017Recruitment PackageNPTMarch 2017Data Use AgreementANPTMarch 2017Operating PlanNPTMarch 2017Facility Commitment LetterCNPTEmail to antibioticsafety@jhmi.edu OrFax to 410-637-4380By April 15th, 2017April 2017IRB approval form (if required by your site)Email to antibioticsafety@jhmi.edu OrFax to 410-637-4380By April 15th, 2017April 2017Implementation ToolkitNPTTo be reviewed prior to July 1st, 2017Phase 1: Planning ActivitiesDate of ActivityActivity DescriptionJanuary 2017 – March 2017RecruitmentMarch 21st, 2017Stakeholder MeetingPhase 2: Onboarding (April 2017)At a GlanceRegister teamsDevelop team rosters and identify Team Leaders Attend Onboarding WebinarsSet up process to import baseline dataHave teams complete HSOPS, NHSOPS or MOSOPS survey as appropriate (or import existing survey data)Have Stewardship Coordinating Team of Team Leader complete the Structural AssessmentDescriptionTeam RegistrationThe 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 RosterThe 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 WebinarsThe 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 CareOnboarding Call #1Goals of The AHRQ Safety ProgramThe Joint Commission Antimicrobial Stewardship Standard and how its goals align with the current programThe timeline of The AHRQ Safety ProgramTechnical and adaptive components of the educational toolkitOnboarding Call #2The Four Moments of Antibiotic Decision-MakingHow the CUSP approach can improve safety cultureUploading and accessing data on the AHRQ Safety Program websiteHow to use the “Appropriateness Tool” to review antibiotic use with frontline staffFor LTCOnboarding Call #1Goals of The AHRQ Safety ProgramThe Centers of Medicare and Medicaid Services requirements for participation related to Antibiotic Stewardship in the LTC settingTimeline of The AHRQ Safety ProgramOnboarding Call #2How the CUSP approach can improve safety cultureTechnical and adaptive components included in the educational toolkitUploading and accessing data on The AHRQ Safety Program websiteFor Ambulatory CareOnboarding Call #1Goals of The AHRQ Safety ProgramReview The Centers for Disease Control and Prevention Core Elements for Outpatient Antibiotic Stewardship Timeline of The AHRQ Safety ProgramOnboarding Call #2How the CUSP approach can improve safety cultureTechnical and adaptive components included in the educational toolkitUploading and accessing data on the The AHRQ Safety Program websiteBaseline DataFacilities 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 CareDays of antibiotic therapy per 1,000 patient days (monthly)Clostridium difficile laboratory event episodes per 10,000 patient days by unit (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. LTCDays of antibiotic therapy per 1,000 patient days (monthly)Number of urine cultures obtained per 1,000 patient days (monthlyAmbulatoryAntibiotic prescriptions per 100 patient visitsThe 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 AssessmentThe 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.InterviewsIn order to better understand behavioral factors influencing antibiotic prescribing, we will be conducting in-person site visits with semi-structured discussions with clinical staff at selected sites. These interviews will be taking place during the baseline and throughout the implementation period.Phase 2: Onboarding DeliverablesDate ProvidedDeliverable DescriptionAppendixProvided byTimeline/DetailsMarch 2017Team RosterStewardship Coordinating Team/Team LeaderElectronically Submit to antibiotic safety@jhmi.edu by May 1st, 2017April 2017Baseline DataSites enter manually or import into data portalBegins April 2017April-May 2017Surveys on Patient Safety CultureSites participate in survey or upload existing survey data into data portalBegins April 2017May 15, 2017Register TeamStewardship Coordinating Team or Team Leader registers team in the project websiteTo be completed prior to implementation periodMay 2017Structural AssessmentTeam leads will fill out the assessment in the project data portalTo be completed prior to implementation periodPhase 3: Implementation (July 2017 – March 2018)At a GlanceParticipate in content calls with teamsFeedback data reports from the data portal to teamsIdentify teams that might need additional follow-upDescriptionContent CallsContent 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 dataTo 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.Phase 3: Implementation ActivitiesDate ProvidedDeliverable DescriptionAppendixProvided byTimeline/DetailsJuly 2017 through March 2018Submit dataFacility TeamsSee data collection schedule in AppendixFebruary/March 2018HSOPsNHSOPSMOSOPSFacility TeamsContent Call ScheduleContent CallsNPTStewardship Coordinating Teams, Team Leaders, frontline staffPhase 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.AppendicesAppendix A: Site Recruitment Letter – Acute Care SettingAHRQ Safety Program for Improving Antibiotic Use in the Acute Care SettingWe 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?Access to experts in both antibiotic stewardship and improving safety culture to assist with troubleshooting and ongoing education.Interactive educational modules, slide sets, and Webinars to improve the understanding of the diagnosis and treatment options of common infections. 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. 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?Identify Team Leaders to assist with overseeing work. 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.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.Appendix B: Site Recruitment Letter – Long-Term Care SettingAHRQ Safety Program for Improving Antibiotic Use in the Long-Term Care SettingWe 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.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 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?Access to experts in both antibiotic stewardship and improving safety culture to assist with troubleshooting and ongoing education.Interactive educational modules, slide sets, and Webinars to improve the understanding of the diagnosis and treatment options of common infections. 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. 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?Identify Team Leaders to assist with overseeing work. 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.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.Appendix C: Site Recruitment Letter – Ambulatory Care SettingAHRQ Safety Program for Improving Antibiotic Use in the Ambulatory Care SettingWe 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.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 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?Access to experts in both antibiotic stewardship and improving safety culture to assist with troubleshooting and ongoing education.Interactive educational eLearning modules, slide sets, and Webinars to improve the understanding of the diagnosis and treatment options of common infections. 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. 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?Identify Team Leaders to assist with overseeing work. 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.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.Appendix D: Acute Care Team Commitment FormAHRQ Safety Program for Improving Antibiotic Use—Acute Care Team Commitment FormInstructionsPrior 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 antibioticsafety@jhmi.edu. IntroductionThis 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 ParticipationThe 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 Requirements1. 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 use3. 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 RequirementsMost 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 AssessmentsHospital Survey on Patient Safety Culture (HSOPS)TwiceStructural AssessmentTwiceDataDays of antibiotic therapy/1,000 patient-daysMonthlyClostridium difficile laboratory event episodes per 10,000 patient days by unit (quarterlyQuarterlyReview of at least 10 patients per month by Team Leaders and/or frontline staff with the Stewardship Coordinating Team using the Antibiotic Appropriateness Tool. Monthly1358210311600Hospital Participation Requirements? Please check the box to indicate you have read and agree to the requirements belowActionDue DateComplete the Hospital Letter of Commitment March 15, 2017Assemble a multidisciplinary team within your hospital unitMarch 15, 2017Complete the Data Use AgreementMarch 15, 2017Register your team to use the project data portalMarch 15, 2017At least one team member attends stakeholder meetingMarch 21, 2017Participate in educational programs including the onboarding/ orientation Webinar series, eLearning Modules and content WebinarsBeginning April 2017Regularly meet as a team to implement interventions and monitor performanceJuly 2, 2017, until end of projectComplete survey assessments and submit hospital unit data according to the data collection scheduleJuly 2, 2017 until end of projectCommitmentCommitmentWe accept the invitation to participate in the AHRQ Safety Program for Improving Antibiotic Use and will comply with the requirements stated above.-388775232850-3723562341400-3545631196871Hospital Executive SignatureDatePrint NamePhysician Lead SignatureDatePrint NameNursing Lead Signature DatePrint NameJohns Hopkins IRB # IRB00112077Sara Cosgrove, M.D., M.S., and Pranita Tamma, M.D., M.H.S. Questions? Email: antibioticsafety@jhmi.eduAppendix E: Long-Term Care Team Commitment FormAHRQ Safety Program for Improving Antibiotic Use—Long-Term CareTeam Commitment FormInstructionsPrior 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 antibioticsafety@jhmi.eduIntroductionThis 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 ParticipationThe 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 Requirements1. Identify Team Leaders to assist with overseeing work. 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 RequirementsThe 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 AssessmentsNursing Home Survey on Patient Safety (NHSOPS)TwiceStructural AssessmentTwiceDataDays of antibiotic therapy/1,000 patient-daysMonthlyProportion of urine cultures obtained/1,000 patient-daysMonthly1358210311600Long-Term Care Participation Requirements? Please check the box to indicate you have read and agree to the requirements belowActionDue DateComplete the LTC Letter of Commitment March 15, 2017Assemble a multidisciplinary team within the LTC unitMarch 21, 2017Complete the Data Use AgreementMarch 15, 2017Register your team to use the project data portalMarch 15, 2017At least one team member attends stakeholder meetingMarch 21, 2017Participate in educational programs including the onboarding/ orientation Webinar series, eLearning modules and content WebinarsBeginning April 2017Regularly meet as a team to implement interventions and monitor performanceJuly 2, 2017, until end of projectComplete survey assessments and submit LTC unit data according to the data collection scheduleJuly 2, 2017, until end of projectCommitmentCommitmentWe accept the invitation to participate in the AHRQ Safety Program for Improving Antibiotic Use and will comply with the requirements stated above.-3210642079825715002268648-3482781109579Facility Executive SignatureDatePrint NamePhysician Lead SignatureDatePrint NameNursing Lead SignatureDatePrint NameJohns Hopkins IRB # IRB00112077Sara Cosgrove, M.D., M.S., and Pranita Tamma, M.D., M.H.S. Questions? Email: 53244758418227Operating Plan00Operating Planantibioticsafety@jhmi.eduAppendix F: Ambulatory Care Team Commitment FormAHRQ Safety Program for Improving Antibiotic Use—Ambulatory CareTeam Commitment FormInstructionsPrior 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 antibioticsafety@jhmi.edu. IntroductionThis 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 ParticipationThe 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 RequirementsIdentify Team Leaders to assist with overseeing work. 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.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 RequirementsIn 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 AssessmentsSurvey on Patient Safety (SOPS)TwiceStructural AssessmentTwiceImplementation AssessmentTwiceDataAntibiotic therapy per 100 patient visitsMonthlyDiagnosis-specific antibiotic prescribing ratesMonthly1358210311600Ambulatory Care Facility Participation Requirements? Please check the box to indicate you have read and agree to the requirements belowActionDue DateComplete the Ambulatory Facility Letter of Commitment March 1, 2017Assemble a multidisciplinary team March 1, 2017Complete the Data Use AgreementMarch 15, 2017Register your team to use the project data portalMarch 15, 2017At least one team member attends stakeholder meetingMarch 21, 2017Participate in educational programs including the onboarding/ orientation Webinar series, eLearning Modules and content Webinars Beginning April 2017Regularly meet as a team to implement interventions and monitor performanceJuly 2, 2017, until end of projectComplete survey assessments and submit facility data according to the data collection scheduleJuly 2, 2017, until end of projectCommitmentCommitmentWe accept the invitation to participate in the AHRQ Safety Program for Improving Antibiotic Use and will comply with the requirements stated above.-2901951119842-31691627642Facility Executive SignatureDatePrint NamePhysician Lead SignatureDatePrint NameJohns Hopkins IRB # IRB00112077Sara Cosgrove M.D., M.S., and Pranita Tamma, M.D., M.H.S. Questions? Email: antibioticsafety@jhmi.eduAppendix G: Data Use AgreementData Use AgreementBetweenNational Opinion Research Center (NORC) AndNAMEThis 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 Antibiotic Stewardship.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 Antibiotic Stewardship; andWHEREAS, 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:SCOPE AND PURPOSEThis Agreement sets forth the terms and conditions pursuant to which Data Provider will disclose the Data Set to DATA RECIPIENT.DATA RECIPIENT will only use the Data Set for the limited purposes necessary to conduct the activities described in Attachment A. OBLIGATIONS AND ACTIVITIES OF DATA RECIPIENTDATA 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.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:Johns Hopkins University (JHU)PARTY NAME HEREPARTY NAME HEREDATA 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.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. 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.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.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. DATA RECIPIENT shall permit onsite inspection by Data Provider and by agencies of the United States government to ensure compliance with this Agreement.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).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.TERM AND TERMINATIONThe 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.The confidentiality provisions of this Agreement shall survive the termination of this Agreement. Upon Data Provider’s knowledge of a breach by DATA RECIPIENT, Data Provider shall: 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 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.MISCELLANEOUS The respective rights and obligations of DATA RECIPIENT under Article 2 of this Agreement shall survive termination of this Agreement. 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. 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. The persons signing below have the right and authority to execute this Agreement and no further approvals are necessary to create a binding agreement. 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:NORCNAME (Data Provider)Signature:Signature:Print Name:Print Name:Title: Title: Date:Date:ATTACHMENT AScope:NORC is the data collection sub-contractor for AHRQ Safety Program for Antibiotic Stewardship. The overall goals of the project are to integrate the appropriate technical and adaptive interventions to improve the use of antibiotics in healthcare. All data will be submitted by NAME to NORC via an encrypted web portal to ensure data security. [The full scope will be specified once all procedures are finalized].Appendix H: Acute Care Call ScheduleAHRQ Safety Program for Improving Antibiotic UseAcute Care eLearning Modules and Schedule of WebinarsDate/TimeTitle and ObjectivesTarget AudienceApril 11th, 20172:00-3:00 ETOnboarding Call #1:By the end of this module, participants will be able to:Understand the goals of the AHRQ Safety Program for Improving Antibiotic UseUnderstand The Joint Commission Antimicrobial Stewardship Standard and how its goals align with the current programUnderstand the timeline of the AHRQ Safety ProgramUnderstand the technical and adaptive components that will be included in the educational toolkitAntibiotic Stewardship Team (optional: unit leaders)April 25th, 20172:00-3:00 ETOnboarding Call #2:By the end of this module, participants will be able to:Apply the Four Moments of Antibiotic Decision-MakingUnderstand how the CUSP approach can improve safety cultureUnderstand how to access data and upload data on the AHRQ Safety Program websiteUnderstand how to use the “Appropriateness Tool” to review antibiotic use with frontline staff Antibiotic Stewardship Team (optional: unit leaders)May 16th, 20172:00-3:00 ETAntibiotic Stewardship Program (ASP) Development:By the end of this module, participants will be able to:Understand the key personnel necessary for developing an ASPDiscuss the pros and cons of the various interventions commonly used by ASPsDiscuss the evaluation approaches used by ASPsUnderstand which senior executives to approach for antibiotic improvement effortsUnderstand how to work with a senior executive to develop a shared understanding of local defectsAntibiotic Stewardship TeamMay 30th, 20172:00 – 3:00 ETImproving 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 useUnderstand that patient harm is largely preventableUnderstand that change efforts often require a focus on systems, not individualsRecognize the principles of sage designUnderstand the importance of diverse input to prevent harmAntibiotic Stewardship Team, unit leaders, and any available frontline StaffJune 6th, 20172:00-3:00 ETBehavior Change Theory for Antibiotic Stewardship Leaders: By the end of this module, participants will be able to: Understand what motivates healthcare providers to prescribe antibioticsUnderstand basic theories regarding implementation science and organizational change to implement antibiotic stewardship interventions and to change prescribing habitsUnderstand successful antibiotic stewardship behavior interventions in the acute care settingAntibiotic Stewardship Team June 27th, 20172:00 – 3:00 ETIdentifying 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 areasUnderstand how to be proactive in asking staff how the next patient will be harmed Understand how to leverage frontline wisdom to guide safety improvement effortsAntibiotic Stewardship Team, unit leaders, and any available frontline staffJuly 11th, 20172:00 – 3:00 ETImproving 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 systemDevelop interventions to reduce future riskEnsure that interventions are effectively addressing defects related to antibiotic prescribingAntibiotic Stewardship Team, unit leaders, and any available frontline staffJuly 25th, 20172:00 – 3:00 ETImproving 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 decisionsUnderstand 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 providersAntibiotic Stewardship Team, unit leaders, and any available Frontline staffAugust 15th, 20172:00 – 3:00 ETTeam Approach to Stewardship of Asymptomatic Bacteriuria (ASB) and Urinary Tract Infections (UTIs):By the end of this module, participants will be able to:Understand how to distinguish asymptomatic bacteriuria, cystitis, and pyelonephritisDevelop empiric treatment recommendations for UTIs that are institution specific and minimize adverse eventsDiscuss opportunities for de-escalation of antibiotic therapy for UTIs after additional clinical data are availableDiscuss reasonable durations of antibiotic therapy for UTIsDiscuss challenges and ambiguities in developing and executing a standardized approach to management of ASB and UTIAntibiotic Stewardship Team, unit leaders, and any available frontline StaffSeptember 19th, 20172:00 – 3:00 ETTeam 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 pneumoniaDevelop empiric treatment recommendations for CAP, COPD exacerbation and aspiration pneumonia that are institution specific and minimize adverse eventsDiscuss opportunities for de-escalation of antibiotic therapy for CAP after additional clinical data are availableDiscuss reasonable durations of antibiotic therapy for CAP, COPD exacerbation, and aspiration pneumoniaDiscuss challenges and ambiguities in developing and executing a standardized approach to management of CAP, COPD exacerbation, and aspiration pneumoniaAntibiotic Stewardship Team, unit leaders, and any available Frontline StaffOctober 10th, 20172:00 – 3:00 ETTeam 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 VAPDevelop empiric treatment recommendations for HCAP and VAP that are institution specific and minimize adverse eventsDiscuss opportunities for de-escalation of antibiotic therapy for HCAP and VAP after additional clinical data are availableDiscuss reasonable durations of antibiotic therapy for HCAP and VAPDiscuss challenges and ambiguities in developing and executing a standardized approach to management of HCAP and VAPAntibiotic Stewardship Team, unit leaders, and any available frontline StaffNovember 14th, 20172:00 – 3:00 ETTeam 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 SSTIsDevelop empiric treatment options for SSTIs that are institution specific and minimize adverse eventsDiscuss opportunities for de-escalation of antibiotic therapy for SSTIs after additional clinical data are availableDiscuss reasonable durations of antibiotic therapy for SSTIsDiscuss challenges and ambiguities in developing and executing a standardized approach to management of SSTIsAntibiotic Stewardship Team, unit leaders, and any available frontline StaffDecember 19th, 20172:00 – 3:00 ETTeam Approach to Stewardship of Intra-Abdominal Infections (IAI):By the end of this module, participants will be able to:Understand the approach to diagnosing IAIsDevelop empiric treatment options for IAIs that are institution specific and minimize adverse eventsDiscuss opportunities for de-escalation of antibiotic therapy for IAIs after additional clinical data are availableDiscuss reasonable durations of antibiotic therapy for IAIsDiscuss challenges and ambiguities in developing and executing a standardized approach to management of IAIsAntibiotic Stewardship Team, unit leaders, and any available frontline StaffJanuary 16th, 20182:00 – 3:00 ETTeam 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 CDIUnderstand when CDI testing is warranted Understand how to distinguish CDI colonization and infectionDiscuss stewardship interventions to reduce CDI Understand treatment approaches for CDIAntibiotic Stewardship Team, unit leaders, and any available frontline staffFebruary 13th, 20182:00 – 3:00 ETCoaching Call About Team-Based Stewardship ImplementationNote: There will not be an eLearning module associated with this webinarBy the end of this module, participants will be able to Discuss barriers to and potential mitigation strategies for implementation of team-based stewardship interventions Antibiotic Stewardship Team, unit leaders, and any available frontline staffMarch 20th, 20182:00 – 3:00 ETSustaining 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 effectDiscuss approaches for identifying new stewardship targetsDiscuss personnel and resources necessary for a stewardship program to successfully be sustainedAntibiotic Stewardship Team, unit leaders, and any available frontline staffAppendix I: Long-Term Care Call ScheduleAHRQ Safety Program for Improving Antibiotic UseLong-Term Care eLearning Modules and Schedule of WebinarsMonth AvailableTitle and ObjectivesTarget AudienceApril 3rd, 20171:00-2:00 ETOnboarding Call #1:By the end of this module, participants will be able to:Understand the goals of the AHRQ Safety Program for Improving Antibiotic UseUnderstand The Centers of Medicare and Medicaid requirements for participation related to Antibiotic Stewardship in the LTC settingUnderstand the timeline of the AHRQ Safety ProgramMaster Trainers (Physician lead, Director of Nursing, and [if available] pharmacist lead)April 17th, 20171:00-2:00 ETOnboarding Call #2:By the end of this module, participants will be able to:Understand how the CUSP approach can improve safety cultureUnderstand the technical and adaptive components that will be included in the educational toolkitUnderstand how to access data and upload data on the AHRQ Safety Program websiteMaster TrainersMay 1st, 20171:00-2:00 ETAntibiotic Stewardship Program (ASP) Development:By the end of this module, participants will be able to:Understand the key personnel necessary for developing an ASPDiscuss the pros and cons of the various interventions commonly used by ASPs in the LTC settingDiscuss the evaluation approaches used by ASPsMaster TrainersMay 22nd, 20171:00-1:30 ETCUSP #1: The Science of Safety:By the end of this module, participants will be able to:Discuss the potential harm associated with antibiotic useUnderstand that patient harm is largely preventableUnderstand that change efforts often require a focus on systems, not individualsRecognize the principles of sage designUnderstand the importance of diverse input to prevent harmMaster Trainers and Frontline StaffJune 5th, 20171:00-1:30 ETCUSP #2: Identifying Defects:By the end of this module, participants will be able to:Understand how to identify patient safety risks in their clinical areasUnderstand how to be proactive in asking staff how the next patient will be harmed Understand how to leverage frontline wisdom to guide safety improvement effortsMaster Trainers and Frontline StaffJune 19th, 20171:00-1:30 ETCUSP #3: Partnering with a Senior Executive:By the end of this module, participants will be able to:Understand which executives to approach for antibiotic improvement effortsUnderstand how to work with an executive to develop a shared understanding of local defectsUnderstand how to develop shared accountability for implementing antibiotic improvement effortsMaster Trainers and Frontline StaffJuly 3rd, 20171:00-1:30 ETCUSP #4: Learning from Defects:By the end of this module, participants will be able to:Understand how to identify the relevant system factors related to defects in the systemDevelop interventions to reduce future riskEnsure that interventions are effectively addressing defects related to antibiotic prescribingMaster Trainers and Frontline StaffJuly 17th, 20171:00-1:30 ETCUSP #5: Improving Teamwork and Communication: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 decisionsUnderstand 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 patientsMaster Trainers and Frontline StaffAugust 7th, 20171:00-1:30 ETAppropriate Collection of Urine SpecimensBy the end of this module, participants will be able to: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)Understand how to obtain a urine culture to minimize the risk of contaminationUnderstand procedures for collecting urine samples from residents with and without urinary cathetersMaster Trainers and Frontline StaffSeptember 11th, 20171:00-1:30 ETDetermining if a Resident has a Urinary Tract InfectionBy the end of this module, participants will be able to:Understand how to interpret the results of a urinalysis and urine cultureUnderstand how to determine if a resident has asymptomatic bacteriuria vs. cystitis vs. pyelonephritisUnderstand alternate diagnoses that can result in change in mental statusMaster Trainers and Frontline StaffOctober 2nd, 20171:00-1:30 ETManagement of Urinary Tract Infections By the end of this module, participants will be able to:Describe empiric treatment options for cystitis vs. pyelonephritisDiscuss opportunities for de-escalation of antibiotic therapy for UTIs after additional clinical data are availableDiscuss reasonable durations of antibiotic therapy for UTIsMaster Trainers and Frontline StaffNovember 6th, 20171:00-1:30 ETDistinguishing Bacterial versus Nonbacterial Causes of Lower Respiratory Tract ConditionsBy the end of this module, participants will be able to:Understand how to distinguish non-antibiotic respiratory conditions) from antibiotic appropriate respiratory conditionsUnderstand when patients with aspiration episodes are likely to and to not benefit from antibiotic therapyUnderstand when patients with asthma exacerbations are likely to and to not benefit from antibiotic therapyMaster Trainers and Frontline StaffDecember 4th, 20171:00-1:30 ETManagement of Lower Respiratory Tract ConditionsBy the end of this module, participants will be able to:Understand the approach to healthcare-associated pneumonia (HCAP)Describe empiric treatment options for HCAPDiscuss opportunities for de-escalation of antibiotic therapy for HCAP after additional clinical data are availableDiscuss reasonable durations of antibiotic therapy for HCAPDescribe management approaches for chronic obstructive pulmonary disease Master Trainers and Frontline StaffJanuary 8th, 20181:00-1:30 ETHow Should I Discuss Infection Concerns about Residents to Antibiotic Prescribers?By the end of this module, participants will be able to:Understand the different kinds of briefings and when to use an Situation, Background, Assessment and Recommendations(SBAR) briefingDescribe the components of SBARImplement SBAR to improve communication between providers and nursing staffRecognize that SBAR can support the role of nurses and nurses as advocates for antibiotic stewardshipMaster Trainers and Frontline StaffFebruary 5th, 20181:00-1:30 ETHow do I Communicate with Family Members that a Resident Will Likely not Benefit from Antibiotic Therapy?By the end of this module, participants will be able to:Discuss the potential harms caused by antibiotics with family membersDiscuss end of life care as it relates to antibiotic useDiscuss approaches to providing supportive care to residents who are uncomfortable, other than prescribing antibioticsMaster Trainers and Frontline StaffMarch 5th, 20181:00-2:00 ETSustaining 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 effectDiscuss approaches for identifying new stewardship targetsDiscuss personnel and resources necessary for a stewardship program to successfully be sustainedMaster Trainers and Frontline StaffAppendix J: Ambulatory Care Call ScheduleAHRQ Safety Program for Improving Antibiotic UseAmbulatory Care eLearning Modules and Schedule of Webinars (Updates Coming)Month AvailableTitle and ObjectivesTarget AudienceApril 25th, 201712:00-1:00 ETOnboarding Call #1:By the end of this module, participants will be able to:Understand the goals of the AHRQ Safety Program for Improving Antibiotic UseDiscuss The Centers for Disease Control and Prevention Core Elements of Outpatient Antibiotic Stewardship Understand the timeline of the AHRQ Safety ProgramMaster Trainers (Physician lead,[and if available] nurse lead and pharmacist lead)May 23rd, 201712:00-1:00 ETOnboarding Call #2:By the end of this module, participants will be able to:Understand how the CUSP approach can improve safety cultureUnderstand the technical and adaptive components that will be included in the educational toolkitUnderstand how to access data and upload data on the AHRQ Safety Program websiteMaster TrainersJune 27th, 201712:00-12:30 ETCUSP #1: The Science of Safety:By the end of this module, participants will be able to:Discuss the potential harm associated with antibiotic useUnderstand that patient harm is largely preventableUnderstand that change efforts often require a focus on systems, not individualsRecognize the principles of sage designUnderstand the importance of diverse input to prevent harmMaster Trainers and Frontline StaffJuly 25th, 201712:00-12:30 ETCUSP #2: Identifying Defects:By the end of this module, participants will be able to:Understand how to identify patient safety risks in their clinical areasUnderstand how to be proactive in asking staff how the next patient will be harmed Understand how to leverage frontline wisdom to guide safety improvement effortsMaster Trainers and Frontline StaffAugust 22nd, 201712:00-12:30 ETCUSP #3: Partnering with a Senior Executive:By the end of this module, participants will be able to:Understand which executives to approach for antibiotic improvement effortsUnderstand how to work with an executive to develop a shared understanding of local defectsUnderstand how to develop shared accountability for implementing antibiotic improvement effortsMaster Trainers and Frontline StaffSeptember 26th, 201712:00-12:30 ETCUSP #4: Learning from Defects:By the end of this module, participants will be able to:Understand how to identify the relevant system factors related to defects in the systemDevelop interventions to reduce future riskEnsure that interventions are effectively addressing defects related to antibiotic prescribingMaster Trainers and Frontline StaffOctober 24th, 201712:00-12:30 ETCUSP #5: Improving Teamwork and Communication: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 decisionsUnderstand 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 patientsMaster Trainers and Frontline StaffNovember 28th, 201712:00-12:30 ETDiagnosis Sinusitis and PharyngitisBy the end of this module, participants will be able to:Discuss when antibiotics may be indicated for sinusitisDiscuss when antibiotics may be indicated for pharyngitisDiscuss treatment options for sinusitis, when antibiotics may be indicatedDiscuss the treatment approach for pharyngitis, when antibiotics are indicatedMaster Trainers and Frontline StaffDecember 19th, 201712:00-12:30 ETAcute Bronchitis and Viral Respiratory Infections (Including Influenza)By the end of this module, participants will be able to:Understand how to interpret the results of a urinalysis and urine cultureUnderstand how to determine if a resident has asymptomatic bacteriuria vs. cystitis vs. pyelonephritisUnderstand alternate diagnoses that can result in change in mental statusMaster Trainers and Frontline StaffJanuary 23rd, 201812:00-12:30 ETThe Diagnosis and Management of Community-Acquired Pneumonia:By the end of this module, participants will be able to:Understand the approach to diagnosing community-acquired pneumonia (CAP)Describe outpatient treatment options for CAPDescribe treatment options for chronic obstructive pulmonary disease exacerbations Master Trainers and Frontline StaffFebruary 27th, 201812:00-12:30 ETHow do I Effectively Communicate with Patients when Antibiotics are Not Necessary?By the end of this module, participants will be able to:Discuss the potential harms caused by antibiotics with patientsDiscuss approaches to providing supportive care to patients who are uncomfortable, other than prescribing antibioticsMaster Trainers and Frontline StaffMarch 27th, 201812:00-1:00 ETSustaining 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 effectDiscuss approaches for identifying new stewardship targets in the outpatient settingDiscuss personnel and resources necessary for a stewardship program to successfully be sustainedMaster Trainers and Frontline StaffAppendix K: Acute Care Team RosterAcute Care Team RosterTeam PositionRole DescriptionMedical Director…Nurse Leader…Pharmacist…RosterHospital NameUnit NameMedical DirectorFirst NameLast NameTitleCredentialsE-Mail AddressNurse LeaderFirst NameLast NameTitleCredentialsE-Mail AddressPharmacistFirst NameLast NameTitleCredentialsE-Mail AddressAppendix L: Long-Term Care Team RosterLong-Term Care Team RosterTeam PositionRole DescriptionMedical Director…Nurse Leader…RosterFacility NameUnit Name (if needed)Medical DirectorFirst NameLast NameTitleCredentialsE-Mail AddressNurse LeaderFirst NameLast NameTitleCredentialsE-Mail AddressAppendix M: Ambulatory Care Team RosterAmbulatory Care Team RosterTeam PositionRole DescriptionPhysician…Nurse…RosterFacility NamePractice Name (if needed)PhysicianFirst NameLast NameTitleCredentialsE-Mail AddressNurseFirst NameLast NameTitleCredentialsE-Mail AddressAppendix N: Timeline for All Site Types ................
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