Electronic Outpatient Antibiotic Stewardship Toolkit

Greetings Leaders in Outpatient Antibiotic Stewardship!

Antibiotic stewardship programs are designed to strategically approach, monitor, reduce and prevent misuse and overuse of antibiotics in healthcare settings. The Centers for Disease Control and Prevention (CDC) core elements of antibiotic stewardship in outpatient settings help guide physicians, emergency departments, urgent care clinics, pharmacies and other outpatient providers in the implementation of a robust antibiotic stewardship progam. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient healthcare settings.
The purpose of this toolkit is to provide outpatient antibiotic stewardship leaders with resources to aid in the implementation of a program inclusive of the CDC Core Elements of Outpatient Antibiotic Stewardship.

A commitment from all health care team members to prescribe antibiotics appropriately and engage in antibiotic prescribing is crucial in improving antibiotic prescribing. Every person involved in patient care can act as an antibiotic steward. Key commitment strategies include:

Write and display public commitments in support of antibiotic stewardship
Identify a single leader to direct antibiotic stewardship activities within a facility
Include antibiotic stewardship related duties in position descriptions or job evaluation criteria
Communicate with all clinic staff to set patient expectations

A Commitment to Our Patients
A Commitment to Our Patients about Antibiotics
Video | CDC Core Elements of Outpatient Antibiotic Stewardship: Commitment

Taking action is the implementation of policies and interventions to promote appropriate antibiotic prescribing practices. A stepwise approach with achievable goals can facilitate policy and practice changes and help clinicians and staff members adjust practices. Assessment and modification and prioritizing of implemented policies and interventions are critical to improving antibiotic prescribing practices.

Use evidence-based diagnostic criteria and treatment recommendations.
Use delayed prescribing practices or watchful waiting, when appropriate.
Provide communications skills training for clinicians.
Require explicit written justification in the medical record for non-recommended antibiotic prescribing.
Provide support for clinical decisions.
Use call centers, nurse hotlines, or pharmacist consultations as triage systems to prevent unnecessary visits.

Antimicrobial Stewardshipz| Quick reference guide – Royal Pharmaceutical Society
ASHP Statement on Pharmacist’s Role in ASP
CDC Adult Treatment Recommendations
CDC Pediatric Treatment Recommendations
CDC | An Antibiotic is the Wrong Tool to Treat A Virus
CDC | Viruses or Bacteria – What’s Got You Sick
Great Plains QIN Viral Prescription Pad
Hospital Pharmacists Guide to ASPs
JAPhA article | A call to action for outpatient antibiotic stewardship
JAPhA article| Outpatient Antibiotic Stewardship: Interventions and opportunities
Outpatient Antibiotic Stewardship Plan Template
Video | CDC Core Elements of Outpatient Antibiotic Stewardship: Action for Policy and Practice
Viral Prescription Pad

Tracking and reporting antibiotic prescribing, also called audit and feedback, can guide changes in practice and be used to assess progress in improving antibiotic prescribing.

Self-evaluate antibiotic prescribing practices.
Participate in continuing medical education and quality improvement activities to track and improve prescribing.
Implement at least one antibiotic prescribing tracking and reporting system.
Assess and share performance on quality measures and established reduction goals addressing appropriate antibiotic prescribing from health plans and payers.

When setting up reporting systems, decisions need to be made about the level at which to track and report, which outcomes to track and report, and how to obtain the data. This core element is flexible to apply to a variety of settings.
Your practice might consider tracking:
*HEDIS or QPP measures
*Antibiotic prescribing for one or more high-priority conditions (e.g. acute bronchitis)
*Percentage of all visits leading to antibiotic prescriptions
*Pharmacies can track vaccinations
*At the system level
*Complications of antibiotic use (e.g. adverse drug events, C. difficile infections)
*Antibiotic resistance trends among common outpatient bacterial pathogens

2018 Quality Payment Program (QPP) Crosswalk
Audit Worksheet for Acute Bronchitis Four Steps to Track Antibiotic Prescribing
Audit Worksheet for Viral Upper Respiratory Infections
CDC: Measuring Outpatient Antibiotic Prescribing
Pharyngitis Tracking Tool
ProPublica Prescriber Checkup: A Quick Guide
Video | CDC Core Elements of Outpatient Antibiotic Stewardship: Tracking and Reporting Video

Providing appropriate antibiotic use education to patients and their family members can improve health literacy and support efforts to improve antibiotic use. Education for clinicians and clinic staff members reinforces appropriate antibiotic prescribing and improves the quality of care.

Clinicians:

Use effective communication strategies to educate patients about when antibiotics are and are not needed.
Educate about the potential harms of antibiotic treatment.
Provide patient education materials.

Outpatient Facilities

Provide face-to-face educational training (academic detailing)
Provide continuing education activities for clinicians
Ensure timely access to persons with expertise

Antibiotics for People with Catheters
CDC Antibiotic Resistance Patient Safety Atlas – Antibiotic Class Definitions
CDC Antibiotic Resistance Patient Safety Atlas
CDC Adult Treatment Recommendations
CDC Continuing Education Courses
CDC Is It Really a Penicillin Allergy? (poster)
CDC Pediatric Treatment Recommendations
CDC Antibiotic Stewardship Print Materials
CDC Print Materials for Adults
CDC Print Materials for Everyone
CDC Print Materials for Parents of Young Children
CDC Viruses or Bacteria What’s Got You Sick? Poster
CDC Weighing in on Antibiotic Resistance: Community Pharmacists Tip the Scale
ENTNET Think Saline Poster
ENTNET Think Twice about Antibiotics for Acute Bacterial Sinusitis – Algorithm Poster
ENTNET Patient Information on Diagnosis of Sinusitis
List of Kansas providers that can perform PCN testing
PCN Allergy Testing
QIO Program Your role in using an antibiotic: Be a a Partner In Your Healthcare
South Dakota GOV Antimicrobial Stewardship Workgroup: Pediatric (Age 5-17 Years) Pharyngitis Guideline
South Dakota GOV Pediatric Acute Bacterial Sinusitis (ABS) Guideline
South Dakota GOV Pediatric (Age > 2 Months) Acute Otitis Media (AOM) Guideline
Stanford CE Course: To Prescribe or Not to Prescribe – Antibiotics and Outpatient Infections
Video | CDC Core Elements of Outpatient Antibiotic Stewardship: Education & Expertise
Viral Prescription Pad

Electronic links to resources and tools are provided for your convenience.

On behalf of Quality Health Associates the Great Plains Quality Innovation Network, thank you fot being a leader in outpatient antibiotic stewardship!

Antibiotic Stewardship Overview and Patient Resources
Antibiotic Stewardship Resources for Healthcare Professionals
Antibiotic Stewardship Programs and Program Development
Core Elements Checklist
Nebraska Antimicrobial Stewardship Program (ASAP)
Outpatient Antibiotic Stewardship Resource List
QIO Program Toolkit for ED and Urgent Care Settings

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