Healthcare professionals engaged in Huron's Team Approach to Antibiotic Stewardship

Relating to different points of view is a valuable personal and professional skill, especially in the healthcare industry. In her 30 years of nursing, Cheri Fast, RN, BSN, WOCN, has certainly developed a strong understanding of the challenges and rewards of positive health outcomes from the patient, family and healthcare professional perspective.

Cheri Fast, RN, BSN, WOCN, program manager for Great Plains QIN- SDAs a program manager with the Great Plains Quality Innovation Network (QIN), Fast is able to combine her experience and passion for case management, chronic disease and wound care to impact antibiotic stewardship, diabetes care and infection prevention at the state and local level. Learn more about this Great Plains QIN content expert from South Dakota in this interview segment.

Q INSIDER Point of View: Cheri Fast, RN, BSN, WOCN

Explain how the work of Great Plains QIN is having an impact on healthcare quality.
By working with healthcare providers and healthcare entities, we are trying to improve the health of our communities. Studying and measuring the right health data is important, but we should never lose sight that caring for people is always the priority. We strive to bring quality care and services and, ultimately, impact the health of all citizens.The Great Plains QIN has many resources, data, tools and individuals who are experts in their fields to assist in improving care across the state.

What do you enjoy most about your job?
I enjoy working on a variety of projects and with a variety of healthcare entities, providers, and communities. I love the collaboration. People in our organization share the same vision and are dedicated to providing quality care.  We support each other and work together. I like being able to contribute my experience and skills from my 30 years in nursing to projects and tasks in healthcare with a practical viewpoint.

Provide some example of successful quality improvement projects you’ve worked on.
Two of the projects I worked on were selected for the 2019 Centers for Medicare & Medicaid Services Quality Conference Gallery Walk. One was focused on antibiotic stewardship and the other related to a Home Health Infection Prevention Toolkit.  I was also chosen as an expert reviewer by Home Health Quality Improvement for their wound care module.

  • Huron, SD – One Community’s Approach to Antibiotic Stewardship
    • Identified top five antibiotic prescriptions
    • Engaged four pharmacies, eight independent clinic and over 20 providers
    • Antibiotic prescribing rate decreased by almost 28% in one year
  • Home Health Infection Prevention Toolkit
    • Partnered with 28 home health agencies and collaborated with national experts
    • Accessed over 7,300 times in all 50 states and 16 countries between April 2018 and December 2018
    • Relative improvement rate of 9.6% region-wide for acute care hospitalization rate related to respiratory, urinary tract and wound infections

What is a key lesson you’ve learned from working with communities on antibiotic stewardship?
Finding the key person in each community that is passionate about the project and willing to get out of their comfort zone was definitely a key lesson. In some rural communities, changing the culture is very difficult.  No two communities or towns are the same. Each community is as unique as each patient.Providers want happy patients and patients expect to receive a prescription when they go to the doctor.  If a patient’s condition is viral in nature, relief from the symptoms will just take time. Providing an antibiotic may please the patient, but it can actually cause more harm.

Explain the role of the pharmacist for preventing adverse drug events.
The role of the pharmacist in preventing adverse drug events is growing and is important for every prescription that is ordered and dispensed. Comparing all the medications for each person, considering allergies and identifying possible medication interactions is important to prevent adverse drug events. Pharmacists also play a key role in educating the patients and communicating with healthcare providers, especially if they question a medication, the dosage, the duration and/or the route.Patients also need to communicate with their pharmacist and provider about all medications they are taking, even over the counter medications, vitamins, and herbal supplements.

Describe some of the challenges you see for medication reconciliation for patients and providers.
The biggest challenges I see with medication reconciliation is when patients have multiple providers, get treated away from their primary care physician and/or fill prescriptions away from their local pharmacy.  For example, patients who are discharged on a weekend and fill medication in another town.

What positive trends and changes are you seeing in healthcare related to prescription drugs?
Prices for common generic medications have dropped, but the cost of specialty medication is outrageous. We need to continually look for alternatives to manage pain. In regards to opioids, although much education is happening throughout the nation and South Dakota as well, more will need to occur. Better Choices, Better Health Chronic Pain Self-Management Workshops are a great resource along with programs such as Avoid Opioid SD and the 211 Helpline.The use of the South Dakota prescription drug monitoring program is one way providers can identify patients’ opioid use. This is especially important if someone is getting prescriptions from multiple providers.

What is the prescription drug monitoring program and why was it developed?
The PDMP was designed to help reduce prescription drug abuse and diversion by allowing prescribers to access and detect whether a patient has been receiving multiple prescriptions for controlled substances including filling or refilling an order for a prescribed opioid.  It was designed to improve prescribing and protect patients.  The PDMP has been available for several years, and online profile queries increase each month, jumping from 7,300 to 56,000 from January 2016 to October 2018.

Why is the opioid epidemic at the level of a national health emergency?
The misuse of opioids is taking a toll on our country, our communities and our families. While emergency room visits, hospitals stays and mental health care add to the financial burden, they hardly compare to the lasting impact of death and the immeasurable  pain of watching someone struggle with or personally experiencing medication addiction.Substance use disorders are chronic medical conditions and should be treated as such. The opioid crisis affects everyone in some way. Its victims are of all ages, races, and walks of life. We must all work together toward a solution. This did not happen overnight, nor will it be solved overnight.  Although South Dakota opioid death rates are low compared to national rates, they are climbing.  According to the Centers for Disease Control and Prevention, the opioids dispensed in 2015 could medicate every American around the clock for 21 days.  The South Dakota comparison medicated our residents around the clock for 19 days.

How can healthcare and communities leaders impact opioid misuse and prevent adverse drug events?
Changing prescribing practices is a priority, but not the only thing that needs to be done. Limiting the supply of prescription opioids, screening and treating individuals and families, raising awareness, taking part in drug take-back programs and finding new methods to treat pain are all ways that providers can make a difference.As a consumer of care, ask questions, get rid of unused prescriptions, don’t share prescriptions, and ask for help if you are struggling. Everyone can take in active role in their care by asking questions and being part of the decision process.

We all need to work to together: healthcare providers and institutions, government agencies, communities, law enforcement, and citizens. Staying educated and being an advocate is key. Seeking non-prescription alternatives, focusing on prevention, removing barriers, and making treatment and support available will all make an impact.