CDC pilots drug use improvement system
Quality group develops driver tool
As a key complement to its new antibiotic use tracking system, the Centers for Disease Control and Prevention is partnering with the Institute for Healthcare Improvement (IHI) in a pilot program to prevent overuse and misuse of antibiotics in hospitals.
"We know across hospitals that there are opportunities to address the overuse and misuse of antibiotics," says Diane Jacobsen, MPH, CPHQ, director of the IHI in Cambridge, MA. "For example, limiting [therapy] to the narrowest spectrum antibiotics that are appropriate or effective would be a huge step to minimize the risk of C. diff and other antibiotic-related adverse events."
The new program uses the IHI "Driver Diagram and Change Package," a quality improvement approach that has been used successfully in other areas.
"We see this as a critical component of our efforts to promote better use of antibiotics in hospitals and healthcare facilities," says Arjun Srinivasan, MD, a medical epidemiologist in the CDC's Division of Healthcare Quality Promotion. "This fits hand in glove with [the CDC antibiotic-use tracking system.] We want people to implement interventions to improve use, but then we also want them to measure use so that they know if their interventions are being successful."
According to the IHI, the driver tool is designed to help organize "theories and ideas about the changes an organization can make to improve outcomes."
The IHI antibiotic program was not available for review as this issue went to press, but officials provided some highlights. Jointly developed by CDC and IHI with guidance and input from a variety of experts, the driver diagram lays out a number of practical steps that hospitals can follow. Ultimately, the idea is to embed the fundamental changes required for antibiotic stewardship in the system of care, especially at the points of care.
"It basically works on improving systems of care," Srinivasan says. "We looked critically at the way antibiotics are used, looked at the available information that has been published, and broke it down into components. We looked for all the different places where antibiotic use could potentially be improved."
For example, unbroken lines of communication are required to ensure therapy is "deescalated" to the narrowest appropriate spectrum, Jacobsen notes. "That is one of the areas that we are focusing on – deescalating to the antibiotic that is most appropriate once you have that culture and sensitivity information back," she says. "But that requires a robust communication system so that the information is reported back and acted on once the cultures and sensitivities are done. Sometimes that can fall by the wayside. "
Indeed, the increasing loss of effectiveness of critical antibiotics is directly linked to this practice, which occurs sometimes because the physician is reluctant to change drugs if the patient seems to be improving, says Robert Rapp, PharmD, a professor of pharmacy at the University of Kentucky Chandler Medical Center.
"Say you have started three drugs for your patient's infection," he says. "You get the cultures back and it happens to be susceptible to a narrow spectrum agent like ampicillin. Then you need to de-escalate to ampicillin and stop the other three. We frequently don't do that. We too frequently just say, 'I'm not sure I believe the culture at this point, my patient is doing a little better, I'm just going to go with what I have.' Frankly, that's killing us."
Role of IP key, but varies
Eight hospitals have agreed to serve as the pilot testing sites for the program. In selecting them, the CDC and IHI looked to engage hospitals of different sizes, areas of expertise, and geographic locations that were willing to test the program across a variety of conditions. The sites include:
- Community Hospital, Tallassee, AL;
- Centerpoint Medical Center, Independence, MO;
- Rogue Valley Medical Center, Medford, OR;
- St. Francis Medical Center, Peoria, IL;
- Seton Medical Center, Austin, TX;
- The Reading Hospital and Medical Center, West Reading, PA;
- Ronald Reagan UCLA Medical Center, Los Angeles, CA;
- WellStar Cobb Hospital, Austell, GA.
An epidemiologist with experience in quality improvement, risk management and infection control, Jacobsen says the role of the infection preventionist will vary across the eight facilities.
"Some of them definitely have included the infection preventionists and/or an epidemiologist on their team," she says. "Others may not, depending upon the structure that they have within the hospital. But as far as the level of interest — the importance of the expertise of that role within an overall antibiotic stewardship program — clearly it is key."
Similarly, some of the hospitals may have different systems of diagnostics or rapid testing, but the IHI driver program underscores communication more than a reliance on technology, she says.
"You can have the best [rapid diagnostics] in the world but if that information doesn't get communicated to the bedside than what good has it done?" Jacobsen says.
As a key complement to its new antibiotic use tracking system, the Centers for Disease Control and Prevention is partnering with the Institute for Healthcare Improvement (IHI) in a pilot program to prevent overuse and misuse of antibiotics in hospitals.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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