Articles

Healthcare Providers Take Part in Quality Initiative to Improve Antibiotic Use

More than 2 million infections and 23,000 deaths occur each year due to antibiotic resistance.1

September 28, 2017

186 Kansas outpatient provider settings have recently committed to become good stewards of antibiotics towards the National Action Plan for Combating Antibiotic-Resistant Bacteria. The primary goal of the national action plan is to slow the emergence of resistant bacteria and prevent the spread of resistant infections.

Why is this important?
Antibiotic resistance is among the greatest public health threats today, leading to an estimated 2 million infections and 23,000 deaths per year in the United States1. At least 30% of outpatient antibiotic prescriptions in the United States are unnecessary2. Antibiotic stewardship is the effort to measure antibiotic prescribing, improve practices to prescribe antibiotics only when needed, improve misdiagnoses or delayed diagnoses leading to underuse, and to ensure the right drug, dose, and duration when an antibiotic is needed. The goal of stewardship is to maximize the benefits of antibiotics while minimizing harm to individual persons and communities.

Kansas providers are participating with other providers throughout the region to become good stewards of antibiotics. These committed partners will work together to discuss and spread the principles of antibiotic stewardship. Recruited partners include community health centers, emergency departments, pharmacies, physician offices, public health clinics, outpatient clinics and urgent care centers. Antibiotic stewardship programs are designed to strategically approach, monitor, reduce and prevent misuse and overuse of antibiotics in healthcare settings. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient healthcare settings. Using antibiotics—in people and in animals—can create drug resistance.

“Many people go to their medical provider with viral illnesses expecting to receive an antibiotic to make them feel better, but don’t understand that the antibiotic they are seeking has absolutely no impact on a virus. Antibiotics cause one out of five emergency department visits for Adverse Drug Events (ADEs). The goal of this initiative is to implement strategies outlined in the CDC Core Elements of Outpatient Antibiotic Stewardship, with the expectation that we can reduce the number of unnecessary antibiotics prescribed in Kansas and reduce some of the potential harm caused by them. We are not saying that antibiotics are bad, but that we all (consumers and prescribers) need to be better stewards of the use of them,” stated Great Plains QIN Project Manager, Nadyne Hagmeier, RN.

The Antibiotic Stewardship initiative is facilitated by the Great Plains Quality Innovation Network (GPQIN), the Quality Innovation Network-Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota. Education, tools and resources, along with best practice strategies and evidence-based resources are available at www.greatplainsqin.org. Great Plains QIN will offer technical assistance to aid all participants to implement what they have learned. Participating providers will benefit from educational and collaborative sessions led by quality improvement experts. Opportunities for networking, learning and sharing across organizations will be made available.

Participants include: ABC Medical Practice, Anderson County Hospital, Augusta Family Practice, Basehor Family and Urgent Care, Central Kansas Family Practice, Chase County Health Department, Cherryvale Family Medical Clinic, Children’s Mercy Hospital-South Campus, Clara Barton Hospital and Medical Clinics, Clay County Health Department, Clay County Medical Center and Family Physicians, Comanche County Hospital and Medical Clinic, Cotton O’Neil Clinics and Express Care, Dighton Pharmacy, Edwards County Medical Center, Eudora Family Care, F.W. Huston Medical Center and Pharmacy, Family Center for Health Care, Family Medicine of Baldwin City and Tonganoxie, Gove County Medical Center, Graham County Hospital Clinic, Great Bend Regional, Harper Hospital District #5 and Rural Health Clinic, Heartland Regional Health Clinic, Hillsboro Community Hospital, Holton Community Hospital, Holton Family Practice Associates, Independence Family Medicine, Irwin-Potter Pharmacy, Jayhawk Pharmacy, Kinsley Health Clinic, Kiowa District Hospital and Clinic, Labette Health and Family Practice. Lane County Hospital and Medical Clinic, Lawrence Memorial Hospital and Clinics, Logan Medical Clinic, McLouth Medical Clinic, Meade District Hospital and Rural Health Clinic, Miami County Medical Center, Midway Clinic, Minneola District Hospital and Community Clinic, Mitchell County Hospital Health System, Morris County Hospital, Mt. Oread Family Practice, Muddy Creek Family Practice, Neodesha Family Medicine, Neosho Memorial Regional Hospital and Clinics, Ness County Hospital and Clinic, Newman Family Medicine, Norton County Hospital and Medical Clinic, Olathe Medical Center, Philips County Access Care and Medical Clinics, Philips County Health System, Plains Rural Health Clinic, Rawlins County Health Center and Clinic, Regional Wound & Hyperbaric Center, Republic County Hospital, Rooks County Hospital and Walk In Clinic, Rush County Memorial Hospital and Medical Clinic, Russell Regional Hospital and Hospital Physicians Clinic, Russell Family Medical Clinic, Sabetha Community Hospital and Family Practice Clinic, Satanta District Hospital and Clinic, Satanta Retail Pharmacy, Smith County Memorial Hospital and Family Practice Clinic, South Central Kansas Regional Medical Center and Clinics, St Luke’s Health System and Clinics, Stevens County, Stormont-Vail Health and Pharmacy, Sublette Clinic, Susan B Allen Memorial Hospital and Clinics, The Internal Medicine Group, Total Family Care, Trego County-Lemke Memorial Hospital, University of Kansas Hospital, Via Christi Clinics and Pharmacy – Wichita, Vohs Pharmacy, Wilson Medical Center, Winchester Medical Clinic, Wolkar Drug.

What you can do to help with antibiotic resistance:

  • Ask if there are steps you can take to feel better and get relief without using antibiotics
  • Take antibiotics exactly as prescribed
  • Safely discard any leftover medication
  • Get recommended vaccinations

What you should not do:

  • Never take antibiotics for viral infections. Antibiotics do NOT cure viral infections, such as colds, flu, most sore throats, most coughs and bronchitis (“chest colds”), many sinus infections and many ear infections
  • Never pressure your doctor to prescribe antibiotics
  • Never skip doses or stop taking an antibiotic early
  • Never save antibiotics for the next time you become sick and do not take antibiotics prescribed for someone else

1CDC. Antibiotic resistance threats in the United States, 2013 [internet]. Atlanta, GA: US Department of Health and Human Services, CDC; 2013.
2Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among U.S. ambulatory care visits, 2010-2011. JAMA 2016;315:1864-73.

What Can the Community Do to Help Combat the Opioid Epidemic?

September 18, 2017

The number of drug overdose deaths has never been higher in the United States (US) and over half of drug overdose deaths involve opioids. The CDC has released prescribing guidelines to help healthcare providers know when opioid use is appropriate, but what can communities do to help combat the epidemic?

The Topeka, Kansas Community Collaborative on Chronic Pain hosted a Drug Take Back Event in July to help eliminate dangerous and unnecessary medications from becoming diverted or misused. At this event, community members can drop off unused medication for safe disposal. Topeka, Kansas is home to approximately 130,000 persons. The Topeka Community Collaborative on Chronic Pain is made up of many supporting agencies in the community, including family service centers, state health department, addiction treatment centers, healthcare organizations and many more. The Kansas Foundation for Medical Care, a partner with the Great Plains Quality Innovation Network, is a Collaborative partner.

The two-hour event was held at a well-known convention center. Via this event, the Collaborative collected nearly 13,000 pills of controlled substances and more than 50 Fentanyl patches, along with a large amount of non-controlled substances (60,000 pills plus 37 pounds of uncounted, non-controlled medication). Collection of these medications will help prevent misuse, diversion and environmental harm from improper medication disposal.

Over 40 Collaborative partners and volunteers united to help fund and host this successful event. Volunteers were needed to help with set up and tear down, direct traffic, collect and count medications and distribute information packets. It is important to allow enough time for skilled volunteers to identify and count controlled substances. Counting pills was time consuming, but considered a best practice for determining the effectiveness of the event. Separating controlled substances from non-controlled substances when reporting on the medication collected gives a more accurate impression of the harm prevented in the community.

Deterra®-brand drug deactivation products were used for disposal of controlled substances. Deterra® bags were also distributed to community members for medication disposal at home. This is a fairly expensive option. If funding does not allow for on-site disposal, communities can partner with law enforcement to determine procedures that can be utilized for collection and disposal. The event was well planned and considered a huge success. Community members appreciated that they did not have to leave their vehicles to drop off their medications for disposal. Many who disposed of medication at this event were elderly and benefited from not having to park and walk into a facility. While a drive-thru system for collecting medications is not required, it is highly recommended. The older community members relayed this was especially helpful.

"This event was an example of what can be achieved when community agencies work together. Within a two hour period of time, we were able to properly dispose of over 75,000 pills, getting unused and unwanted medication out of medicine cabinets, reducing the likelihood of overdose, misuse or improper disposal," stated Stacy Forgy, LMSW, at Valeo Behavioral Health Care.

As a result of this event, the Collaborative is partnering with the Kansas Foundation for Medical Care to develop a Drug Take Back Event Toolkit for other communities to utilize in planning similar events.

The Great Plains Quality Innovation Network partners with providers, pharmacists and stakeholders in the region to reduce and monitor Adverse Drug Events (ADEs). A specific strategy to advance this work is to monitor Medicare consumer ADE rates on several prescription medications; one being opioids. Learn how you can partner with our team to reduce ADEs by visiting our website.

Gove County Medical Center LTC: One Team, One Vision, One Goal

July 14, 2017

Gove County Medical Center Long Term Care Unit is a 37-bed Intermediate Care Facility based in Quinter, Kansas. In July 2015, the Long Term Care Facility team decided they needed to improve their long-stay Quality Measure (QM) performance. After review, the team established three goals:

  • Reduce their overall composite score of 13.21 percent; the national average is 7.92 percent;
  • Reduce antipsychotic medication rate from 29.06 percent; by comparison, the state average is 20 percent and the national average is 15.7 percent;
  • Reduce the falls rate from 19.35 percent; by comparison, the state average is 54.9 percent and the national average is 45.3 percent.

The Gove County leadership team consulted Brenda Groves, LPN, Regional Nursing Home Lead for the Great Plains Quality Innovation Network and scheduled monthly coaching calls with the leadership team. To achieve their goal, the coaching calls provided suggestions of best practices for improvement, resources and education for staff.

The team achieved their goal of improved QM performance by implementing staffing shift changes and educating staff to incorporate the best practices needed to improve independence, increase mobility and decrease infections of their residents. Through hard work and dedication, Gove County Medical Center Long Term Care Facility achieved their goal. Their current long-stay composite score is 6.94 percent, antipsychotic medication reduction is 13.79 percent and falls is 17.24 percent. Residents also report that the facility is "calmer" because anxiety from residents have decreased tremendously, allowing staff to discontinue the use of some anti-anxiety medications.

"Success is dependent on teamwork and communication. Our motto is one team, one vision, one goal. We will continue to provide education specific to each resident, continue hourly checks and limit alarms. We will also provide exercise appropriate for our residents’ needs to help them remain as strong as they can for as long as possible. The true measure of your strength and character is how you handle adversity, not how you deal with success," stated Sudden Carroll, CNA and Denise Woodworth, RN, DON, at Gove County Medical Center.

For more information about Gove County Medical Center Long Term Care Facility and their efforts, visit govecountymedicalcenter.org.

 

APIC Training Offered in Kansas

Great Plains Quality Innovation Network (QIN) is partnering with nursing homes across the region to prepare them for future quality reporting requirements, improve infection control practices and improve resident outcomes. The Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) provides a certificate of training to those working in long-term care with a baseline of infection prevention and control knowledge, as well as provides best practices in infection prevention and control to improve patient care in the long-term care practice setting.

APIC, in partnership with the Great Plains QIN and the Kansas Department of Health and Environment is currently hosting a free four-day onsite, highly-interactive training course over the course of two months in Wichita, Kansas. There were 128 registrants; only 75 seats available. First priority for attendance was given to nursing homes fully enrolled in the NHSN system and reporting data as part of the Cdifficile Reporting & Reduction Initiative.

Days 1 and 2 of the in-person training were held on July 17 and 18. Following this session, trainees are required to complete the APIC assigned on-line classes. Days 3 and 4 of the in-person training will be held on August 28 and 29. After completion of all in-person and online training requirements, trainees will take an exam; a certificate of training is awarded to those who score 75% or higher. Continuing Education credit is also available to nurses who attend; all trainees will receive a free 1-year APIC membership.

For more information on how Great Plains Quality Innovation Network is working with nursing homes to reduce preventable healthcare conditions, click here.

 

Colorectal Cancer Screening Improvement Efforts Earn National Recognition

Great Plains Quality Innovation Network honored during National Colorectal Cancer Awareness kick-off event

March 7, 2017

The Kansas Foundation for Medical Care, Inc. (KFMC), a not-for-profit organization based in Topeka, KS, recently earned national recognition for efforts to improve colorectal cancer screening rates. KFMC is a member of the Great Plains Quality Innovation Network, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Kansas, Nebraska, North Dakota and South Dakota. The Great Plains QIN was chosen by the National Colorectal Cancer Roundtable (NCCRT) to receive the 2017 80% by 2018 National Achievement Honoree Award. This prestigious national honor recognizes leadership in the ongoing effort to increase colorectal cancer screening rates across the United States. Following a competitive review of nominees, Great Plains QIN was chosen as one of six organizations from across the country to be recognized for their dedication of time, talent and expertise to advancing initiatives that support the shared goal to regularly screen 80% of adults age 50 and over by 2018.

Co-founded by the American Cancer Society and the Centers for Disease Control and Prevention, the NCCRT is chaired by Dr. Richard Wender, chief cancer control officer for the American Cancer Society. “We are moving full speed ahead in our efforts to reach an ambitious public health goal: an 80% colorectal cancer screening rate by 2018. Fortunately, we have boots on the ground working every day to reach this goal. Their work is relentless, their successes are enormous, and I’m confident that they are saving lives,” Wender stated.

Great Plains QIN Chief Executive Officer Tina Georgy considered the success a regional effort, "Partnering with stakeholders from across the four-state region increased awareness of the value of colorectal cancer screening. The collective effort of stakeholders and staff providing education and support resulted in increased screening rates and the expansion of the innovative FluFIT program into a variety of settings, including federally qualified health centers (FQHC), Indian Health Service clinics and pharmacy sites."

To be recognized for this honor, Great Plains QIN facilitated a regional Learning and Action Network, a collaborative effort focused on the importance of colorectal cancer screenings. Education and training was offered as well as technical assistance to support evidence-based systems change interventions at 57 clinics, 17 of which are Kansas practices. Of the 43 clinics currently able to track their screening rates, all have reported improvements; one Kansas practice, Prairie Star Family Practice in Plainville, Kansas, screened as many as 84% of eligible patients.

Sarah Irsik-Good, Director of Quality Improvement at KFMC, reflected on the achievement of Prairie Star Family Practice, “We are very excited that one of our Kansas practices has already achieved the 80% screening goal well ahead of the 2018 mark! We are working to harness their success, promising practices and lessons learned to help other practices improve by providing a model that has proven to work in the rural Kansas healthcare environment.”

Dr. Jen Brull, physician owner of Prairie Star Family Practice, recently presented their improvement journey to participating practices across the four state Great Plains region and shared the following about their success, “One of my passions is performance improvement, so the process of improving our colon cancer screening rate is one that is interesting to me at base. The benefit to my patients of earlier detection is one I strongly support and love to tell patients about. I suspect my enthusiasm for both contributes to my team's success at getting patients screened.”

Collaborations with a diverse group of healthcare organizations across the region raise awareness of the value and options for colorectal cancer screening. Shannon Bacon, health systems manager for the Great West Division of the American Cancer Society remarked, “Great Plains QIN has been a vital partner in improving colorectal cancer screening rates across their four-state region. Staff expertise, leadership and willingness to collaborate with other organizations have resulted in more people being screened for colorectal cancer. I truly believe that lives will be saved as a result of their success.”

The NCCRT hosted honorees, including Great Plains QIN team members, for a recognition event to kick off National Colorectal Cancer Awareness Month on March 1 in New York City's Times Square. Find the full list of 2017 80% by 2018 National Achievement Award winners and detailed information on the NCCRT at http://nccrt.org.