Difference between revisions of "BMI537 template"

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==Problem Statement==
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Problem Statement and introduction
  
Scope of Problem
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===Scope of Problem ===
Published reports suggest that ASM is a significant problem. Buising and colleagues[1] noted that in a population of adult ICU patients, 14.3% of sterile and 30.8% of non-sterile isolates were treated inadequately initially, 4.0% of sterile and 21.3% of non-sterile isolates were treated inadequately after identification, and narrower-spectrum therapy was available for 30% of patients after microbe identification. In addition, Paterson et al[2] reported that 52% of mismatches occurred in patients who previously received a drug that was shown to be inadequate against the infecting organism, 30% of patients had a prior history of a drug’s ineffectiveness against an organism, and 62.5% of mismatches occurred in patients staying 14 days or longer (i.e., intensive care unit patients, cancer patients). These reports indicate that there are clear patterns and risk factors that describe ASM. Therefore, the process of identification and intervention for ASM is a particularly well-suited target for ongoing quality improvement efforts, which could identify workflow causes or process failures that promote ASM.
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Published reports suggest that antibiotic susceptibility mismatch (ASM) is a significant problem. Buising and colleagues[1] noted that in a population of adult ICU patients, 14.3% of sterile and 30.8% of non-sterile isolates were treated inadequately initially, 4.0% of sterile and 21.3% of non-sterile isolates were treated inadequately after identification, and narrower-spectrum therapy was available for 30% of patients after microbe identification. In addition, Paterson et al[2] reported that 52% of mismatches occurred in patients who previously received a drug that was shown to be inadequate against the infecting organism, 30% of patients had a prior history of a drug’s ineffectiveness against an organism, and 62.5% of mismatches occurred in patients staying 14 days or longer (i.e., intensive care unit patients, cancer patients). These reports indicate that there are clear patterns and risk factors that describe ASM. Therefore, the process of identification and intervention for ASM is a particularly well-suited target for ongoing quality improvement efforts, which could identify workflow causes or process failures that promote ASM.
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===Impact===
  
Impact: 
 
 
Published research reviewed in developing the guideline reported various improvements in antimicrobial use and patient outcomes, among them: a) a 22% to 36% decrease in antimicrobial use through more efficient prescribing practice and use of less expensive alternatives; b) savings of $200,000 to $900,000 in direct drug costs (savings dependent on institution size); c) short-term susceptibilities among gram-negative pathogens (e.g., Klebsiella); d) reduced use of broad-spectrum antimicrobials by 34% to 84%; and e) modification of 25% of antimicrobial orders, with prescription of narrower-spectrum drugs in 47% of these cases.[3]
 
Published research reviewed in developing the guideline reported various improvements in antimicrobial use and patient outcomes, among them: a) a 22% to 36% decrease in antimicrobial use through more efficient prescribing practice and use of less expensive alternatives; b) savings of $200,000 to $900,000 in direct drug costs (savings dependent on institution size); c) short-term susceptibilities among gram-negative pathogens (e.g., Klebsiella); d) reduced use of broad-spectrum antimicrobials by 34% to 84%; and e) modification of 25% of antimicrobial orders, with prescription of narrower-spectrum drugs in 47% of these cases.[3]
  
Setting
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===Setting===
 +
 
 
A large metropolitan children's hospital
 
A large metropolitan children's hospital
  
Aim
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===Aim===
 +
 
 
To reduce the use of ineffective antibiotics for documented infections  
 
To reduce the use of ineffective antibiotics for documented infections  
  
Specific Goal:   
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===Specific Goal===
 +
 
 
To reduce the incidence of antibiotic susceptibility mismatches (ASM) for documented infections in urine and bloodstream through active surveillance of culture results and antibiotic use
 
To reduce the incidence of antibiotic susceptibility mismatches (ASM) for documented infections in urine and bloodstream through active surveillance of culture results and antibiotic use
  
 
==Process and Prioritization==
 
==Process and Prioritization==
  
Process Affected
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===Process Affected===
Patients from In-patient area come to the operating room for surgical procedure. About 50% of the patients are delayed from getting into to the operating room due problems with patient location. If we have a solution in the structure of a patient tracking system would improve/solve this problem. The implementation of Active RFID (radio frequency Identification Tag) would track patients in real time and help improve this problem.
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The process of selection of antibiotics at various stages of microbiology reporting will be affected.
  
 
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Measure(s):  ASMs per week and average length of stay during the 26 weeks before and the 26 weeks after implementation of an antibiotic audit and feedback intervention
Measure(s)
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95% improvement in patient tracking between Inpatient areas and operating room would significantly improve efficiency and improve productivity.
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==Intervention==
 
==Intervention==
Plan
 
 
 
Do
 
 
Study
 
 
Act
 
 
==Reference==
 
 
Be sure to reference your work.
 
 
1. http://www.qualitytools.ahrq.gov/qualityreport/download/download_report.aspx
 
 
2. RFID Application in Hospitals: A Case Study on a Demonstration RFID Project in a Taiwan Hospital
 
Shang-Wei Wang  Wun-Hwa Chen  Chorng-Shyong Ong  Li Liu  Yun-Wen Chuang 
 
National Taiwan University;
 
This paper appears in: System Sciences, 2006. HICSS '06. Proceedings of the 39th Annual Hawaii International Conference on
 
Publication Date: 04-07 Jan. 2006
 
Volume: 8, On page(s): 184a- 184a
 
ISSN: 1530-1605
 
ISBN: 0-7695-2507-5
 
Digital Object Identifier: 10.1109/HICSS.2006.422
 
Posted online: 2006-01-23 09:16:15.0
 
 
3. Study: RFID in hospitals shows ROI promise
 
12/06/2004 07:43 AM
 
By Dyke Hendrickson
 
http://www.masshightech.com/displayarticledetail.asp?art_id=67320&search=PanGo+
 
 
http://masshightech.bizjournals.com/masshightech/stories/2004/12/06/story9.html
 
 
4.RFID in the Hospital
 
RFID to improve patient safety and hospital savings
 
RFID Gazette
 
  
http://www.rfidgazette.org/2004/07/rfid_in_the_hos.html
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=== Plan ===
  
5. 5th RFID, Barcoding and Emerging Technologies for Hospitals and Health Systems
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Antimicrobial stewardship programs and guidelines for the appropriate use of antibiotics are reviewed and compared with the hospital's current ASM rate.
Integrating Innovative Solutions for Increasing Patient Safety, Reducing Medical Errors and Improving Workflow
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September 18 - 21, 2006 •  Hilton Philadelphia City Avenue, Philadelphia, PA
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http://www.iqpc.com/cgi-bin/templates/genevent.html?topic=483&event=10612&
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=== Do ===
  
6. Maybe RFID? Healthcare Organizations Slowly Expanding Adoption of RFID Technology
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The ASM rate is monitored for 26 weeks without action. The hospital begins flagging ASMs in lab results for a second 26-week so physicians can change antibiotic orders. Average length of stay (LOS) in the hospital for patients receiving antibiotics is monitored through both 26-week periods.
By Elizabeth S. Roop
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For The Record
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Vol. 18 No. 14 P. 18
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http://www.fortherecordmag.com/archives/ftr_07102006p18.shtml
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 +
=== Study ===
  
 +
The investigators study the ASM and LOS data to identify underlying cause(s) of failure to recognize and/or act on ASMs.
  
 +
=== Act ===
  
 +
The hospital implements additional intervention(s) such as electronic alerts and one-to-one physician counseling to further reduce the ASM rate and, potentially, the average LOS.
  
 +
== References ==
  
 +
# Buising KL, Thursky KA, Bak N, Skull S, Street A, Presneill JJ, Cades JF, Brown GV. Antibiotic prescribing in response to bacterial isolates in the intensive care unit. Anaesth Intensive Care. 2005 Oct;33(5):571-7.
 +
# Paterson DL, McKinnon J, Ndirangu M, Capitano B, Potoski B, Linden PK. Why do doctors give microbiologically inadequate empiric therapy to critically ill patients? Abstr Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43:abstract no. K-1419.
 +
# Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM, Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007 Jan 15;44(2):159-77. Epub 2006 Dec 13.
  
 
Return to [[Quality Informatics]]
 
Return to [[Quality Informatics]]
  
 
[[category:BMI537-F-07]]
 
[[category:BMI537-F-07]]

Latest revision as of 18:59, 6 December 2011

Problem Statement and introduction

Scope of Problem

Published reports suggest that antibiotic susceptibility mismatch (ASM) is a significant problem. Buising and colleagues[1] noted that in a population of adult ICU patients, 14.3% of sterile and 30.8% of non-sterile isolates were treated inadequately initially, 4.0% of sterile and 21.3% of non-sterile isolates were treated inadequately after identification, and narrower-spectrum therapy was available for 30% of patients after microbe identification. In addition, Paterson et al[2] reported that 52% of mismatches occurred in patients who previously received a drug that was shown to be inadequate against the infecting organism, 30% of patients had a prior history of a drug’s ineffectiveness against an organism, and 62.5% of mismatches occurred in patients staying 14 days or longer (i.e., intensive care unit patients, cancer patients). These reports indicate that there are clear patterns and risk factors that describe ASM. Therefore, the process of identification and intervention for ASM is a particularly well-suited target for ongoing quality improvement efforts, which could identify workflow causes or process failures that promote ASM.

Impact

Published research reviewed in developing the guideline reported various improvements in antimicrobial use and patient outcomes, among them: a) a 22% to 36% decrease in antimicrobial use through more efficient prescribing practice and use of less expensive alternatives; b) savings of $200,000 to $900,000 in direct drug costs (savings dependent on institution size); c) short-term susceptibilities among gram-negative pathogens (e.g., Klebsiella); d) reduced use of broad-spectrum antimicrobials by 34% to 84%; and e) modification of 25% of antimicrobial orders, with prescription of narrower-spectrum drugs in 47% of these cases.[3]

Setting

A large metropolitan children's hospital

Aim

To reduce the use of ineffective antibiotics for documented infections

Specific Goal

To reduce the incidence of antibiotic susceptibility mismatches (ASM) for documented infections in urine and bloodstream through active surveillance of culture results and antibiotic use

Process and Prioritization

Process Affected

The process of selection of antibiotics at various stages of microbiology reporting will be affected.

Measure(s): ASMs per week and average length of stay during the 26 weeks before and the 26 weeks after implementation of an antibiotic audit and feedback intervention

Intervention

Plan

Antimicrobial stewardship programs and guidelines for the appropriate use of antibiotics are reviewed and compared with the hospital's current ASM rate.

Do

The ASM rate is monitored for 26 weeks without action. The hospital begins flagging ASMs in lab results for a second 26-week so physicians can change antibiotic orders. Average length of stay (LOS) in the hospital for patients receiving antibiotics is monitored through both 26-week periods.

Study

The investigators study the ASM and LOS data to identify underlying cause(s) of failure to recognize and/or act on ASMs.

Act

The hospital implements additional intervention(s) such as electronic alerts and one-to-one physician counseling to further reduce the ASM rate and, potentially, the average LOS.

References

  1. Buising KL, Thursky KA, Bak N, Skull S, Street A, Presneill JJ, Cades JF, Brown GV. Antibiotic prescribing in response to bacterial isolates in the intensive care unit. Anaesth Intensive Care. 2005 Oct;33(5):571-7.
  2. Paterson DL, McKinnon J, Ndirangu M, Capitano B, Potoski B, Linden PK. Why do doctors give microbiologically inadequate empiric therapy to critically ill patients? Abstr Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43:abstract no. K-1419.
  3. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM, Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007 Jan 15;44(2):159-77. Epub 2006 Dec 13.

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