Prescribing antibiotics when they aren’t necessary—such as for colds or sinus infections—or prescribing the wrong type, can contribute to antibiotic resistance. According to the Centers for Disease Control and Prevention, antibiotic-resistant infections, once rare outside of the hospital setting, are becoming more common in outpatient settings including doctors’ offices and emergency departments.
Health Quality Innovators (HQI), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Maryland and Virginia, and the Atlantic Quality Innovation Network (AQIN), the QIN-QIO for the District of Columbia, New York and South Carolina, have been helping MedStar Health—the largest health care provider in Maryland and the Washington, D.C. region—reduce the threat of antibiotic resistance. The QIN-QIOs are accomplishing this by educating medical staff about the importance of appropriate antibiotic prescribing and by helping MedStar’s outpatient facilities implement an antibiotic stewardship program.
HQI and AQIN hold strategy calls to determine the best way to deliver resources and technical assistance. “We want to help MedStar approach antibiotic stewardship from the system level,” said Katie Richards, improvement consultant at HQI. “Since HQI and AQIN both serve MedStar, it’s important for us to work together to avoid duplication of efforts and to provide consistent messaging, data reports, tools and resources to each of MedStar’s outpatient facilities.”
There are four core elements of antibiotic stewardship:
Together, HQI and AQIN worked to get commitment from MedStar to work on antibiotic stewardship and to identify a stewardship leader, which fulfilled the first core element. The QIN-QIOs also developed an outpatient antibiotic stewardship toolkit, including resources for achieving each of the four core elements, examples of antibiotic stewardship policies, and educational posters.
Working closely with MedStar’s stewardship leader Dr. Ryan Anderson, MPP, associate medical director for quality and safety, HQI and AQIN helped MedStar achieve the second core element by providing best practices for antibiotic prescribing and offering guidance on MedStar’s draft antibiotic prescribing guidelines. The QIN-QIOs also developed a prescriber information resource to help clinicians determine the appropriate type of antibiotic, duration and dosage. HQI and AQIN are working with MedStar to meet its goal of building an antibiotic order set into its electronic health record (EHR) system, a task the health system has started within its hospital setting but is still developing for its outpatient clinics and providers. Order sets are important because they help “promote safe, efficient, evidence-based patient care,” according to a study published in PubMed.
"HQI and AQIN have been valuable partners in improving MedStar's stewardship of ambulatory antibiotic use. The data these organizations provide give us a better understanding of where our practices vary in their adherence to best practices. Understanding variability is a key component to improving quality."
Through quarterly data reports, HQI and AQIN are helping MedStar achieve the third core element, Tracking and Reporting. Each report highlights the total number of antibiotics prescribed, notes potentially inappropriate prescribing practices and identifies possible adverse drug events associated with antibiotics.
“HQI and AQIN have been valuable partners in improving MedStar’s stewardship of ambulatory antibiotic use, said Anderson. “The data these organizations provide give us a better understanding of where our practices vary in their adherence to best practices. Understanding variability is a key component to improving quality.”
While education, the fourth core element, is ongoing with MedStar providers, HQI and AQIN have developed a patient education presentation for MedStar facilities to use with specific patient populations. “The presentation explains what antibiotic resistance is and why it’s a concern, highlights the differences between bacteria, viruses and fungi, and emphasizes the importance of the patient’s role in understanding antibiotic stewardship as part of the care team,” said Jennifer Thomas, Pharm.D., medication safety, immunizations, and antibiotic stewardship lead at AQIN-DC. The next step is to distribute an animated video based on the presentation for MedStar facilities to share with patients in their waiting rooms.