Louisiana success stories

LA Success Stories
Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. 

We encourage you to read the success stories, contact us for more information, and also let us know if you have a Quality Insights' success story to share.

Hospital Improves Outpatient Antibiotic Stewardship Practices With the Help of a Multidisciplinary Committee

4/9/2019
St. Bernard Parish HospitalSt. Bernard Parish Hospital opened its doors in August of 2012.  The former parish hospital, Chalmette Medical Center, was destroyed in 2005 in the wake of Hurricane Katrina. A new hospital provided the opportunity to not only acquire state of the art equipment but also to adopt current evidence-based practices to ensure the provision of safe, quality care for patients.
 
Hospital leaders immediately began developing various quality improvement teams within the organization. In August 2016, a multidisciplinary antimicrobial stewardship committee was formed to improve antibiotic usage practices within the organization. The committee implemented a plan of work which included engaging Quality Insights for their assistance.
 
When St. Bernard Parish Hospital began working with Quality Insights, the antimicrobial stewardship committee had already drafted the hospital’s first policy for antimicrobial stewardship. Kathy Nicolay, St. Bernard’s Director of Pharmacy, was named as the hospital leader responsible for directing antimicrobial stewardship activities. The antimicrobial stewardship committee’s initial steps towards improving antibiotic usage included training for providers and nursing staff on the hospital’s most recent antibiogram as well as revision of emergency department (ED) order sets for sepsis, pneumonia, sinusitis, and bronchitis to ensure antibiotic choices were reflective of evidence-based recommendations. 
 
In the summer of 2017, the committee developed the hospital’s first antibiotic stewardship newsletter which was circulated to staff and providers. In November of 2017, with new management by Ochsner Health System and a new EMR, came the availability of the first reports to electronically track and report the number of ED visits leading to antibiotic prescriptions and antibiotic prescribing patterns by condition. The antimicrobial stewardship committee was able to utilize these reports to focus provider education in areas identified as requiring improvement. 
 
One obstacle that many of the ED providers faced was patients’ frequent requests for antibiotics for known viral illnesses. To acknowledge the patients’ concerns, the committee developed an Outpatient Over the Counter (OTC) Order Form that ED providers gave to patients upon discharge which suggested OTC medications to alleviate their symptoms, and often their anxiety, about their illness.
 
Other elements for improvement in antimicrobial stewardship practices were initiated throughout the project’s scope of work such as display of signage demonstrating the hospital’s commitment to antibiotic stewardship and patient education through flyers and video loops in the emergency department regarding appropriateness of antibiotics as well as potential harms associated with antibiotic therapy.  In 2018, realizing that public awareness is paramount in improving antibiotic usage practices, the hospital also initiated a patient engagement group in which information regarding antimicrobial stewardship was shared. 
 
Through the antimicrobial stewardship committee and its partnership with Quality Insights, as well as the commitment of hospital leadership and the Medical Staff Performance Improvement (MSPI) Committee, the hospital has made great strides over the last three years in ensuring quality care for its patients through improvements in antibiotic usage practices. Going forward, the committee will continue to monitor outpatient antibiotic usage patterns and formulate action plans as needed, but the focus will shift to inpatient antibiotic stewardship. The experience gained through the committee’s collaboration with Quality Insights in the last three years will certainly contribute to the antimicrobial stewardship committee’s continued work in ensuring quality care for patients through ongoing improvements in antibiotics usage practices.