Article by AHRQ

The Agency for Healthcare Research and Quality (AHRQ) has announced a free, 12-month national project for LTC facilities to receive antibiotic use guidelines, expert coaching, online education, improvement tools, and patient education materials.

The program will begin in December 2018. Facilities must sign up to be eligible; the deadline to enroll in the program is November 30, 2018. An hour-long informational webinar will be held over the next few months. See schedule below. Please click to learn more about the program and attend an upcoming informational webinar.

Frequently Asked Questions

1. What are the benefits of participating?
Our antibiotic stewardship team will work closely with members of your facility to develop or enhance your antibiotic stewardship priorities and commitments. Using evidence-based, scientific literature and practical implementation strategies, we can help your multidisciplinary team understand the drivers of antibiotic prescribing, improve its knowledge of antibiotic use, and identify approaches to optimizing antibiotic use.

Our team of physicians and quality improvement experts has expertise in antibiotic stewardship and will be readily accessible for coaching, technical assistance, and ongoing education. Full participation in this program will assist with compliance with the Centers for Medicare & Medicaid Services’ (CMS) requirement for long-term care (LTC) facilities to implement antibiotic stewardship programs by 2020. Potential benefits of participation include—

  • Enhancing teamwork and communication
  • Reducing unnecessary antibiotic use
  • Reducing Clostridium difficile infection (CDI) rates
  • Improving resident and family satisfaction
  • Earning free continuing education credits for attending educational webinars
  • Earning a Certificate of Participation for facilities that successfully submit requested data
  • Earning a Certificate of Completion for facilities that complete the entire program.

2. What is antibiotic stewardship?
Antibiotics decrease morbidity and mortality when used appropriately, but overuse of antibiotics contributes to both the increasing rate of CDI and the emergence of antimicrobial resistance. Antibiotic stewardship refers to the coordinated efforts to improve the use of antibiotics by promoting the selection of the optimal antibiotic regimen, dose, duration of therapy, and route of administration, when antibiotics are needed.

3. What does it cost our facility to participate in the program?
Participation in the program is free. Participating facilities will not incur any fees to receive facilitation as a part of this program and will not receive any payment for their participation.

4. What is the timeline of the program?
This program asks for a 1-year commitment. Onboarding/orientation Webinars to introduce the program and train representatives from your site about antibiotic stewardship will begin in December 2018. Data collection will begin in January 2019.

5. What is required of our facility in order to participate in the program?
Each site would identify a stewardship team (e.g., nurse, physician, consulting pharmacist) to assist with overseeing work. Activities include—

  • Participating in regular 30 minute Webinars. Participants will receive training via Webinars held once or twice per month.
  • Determining and implementing approaches to improve antibiotic use. Using approaches discussed in the Webinars, stewardship teams will develop and implement approaches for a daily review of residents who are receiving antibiotics and optimize antibiotic therapy. In addition, teams will participate in assessing issues with how antibiotics are prescribed and administered in their facility and developing improvement plans.
  • Collecting and reviewing data. Your stewardship team and frontline staff are encouraged to work together to review antibiotic use data.

6. How much time does this program take per month?
We anticipate that the stewardship team and other participating clinical staff will likely need to spend a minimum of 4 hours per month on the AHRQ Safety Program for Improving Antibiotic Use. Approximately 1 hour would be devoted to participating in Webinars. The remaining 3 hours would be spent having team meetings to discuss specific antibiotic-related issues and working through the Four Moments of Antibiotic Stewardship Tool.

7. When is the deadline to enroll?
The deadline to enroll in the program is November 30, 2018.

8. Is a contract required to participate in the program?
No, a contract is not required to participate in the program. To apply for the program your facility’s administrator or other primary contact will need to complete the online application form available here.

The program then requests a letter of commitment signed by an administrator, director of nursing, and/or medical director or other physician champion. This is not a contract; rather, it is an agreement to work with us. We ask for these signatures to ensure support for the program from the facility’s leadership and to approve the minimum time commitment of 4 hours per month. However, the actual program commitments/requirements will be fulfilled by the stewardship team and frontline staff.

9. Is a data use agreement (DUA) required to participate in the program?
No, a DUA is not required for participation in the program. The data are being collected both for program assessment purposes and as a tool for each site’s own quality improvement efforts. Each site should use the data it collects to evaluate its antibiotic use and antibiotic stewardship efforts. NORC and Johns Hopkins Medicine will use the collected data to assess the adoption and effectiveness of the program overall. Additionally, each site can compare its antibiotic use to similar facilities.

Since the program is only requesting de-identified information and is not requesting any PHI, a data use agreement is not required for participation in this program. However, if your facility determines that it still needs a DUA to define the transaction, we can provide a template for your review.

10. What material do I need to complete before the program begins?
You need to complete the online application and a letter of commitment. The letter of commitment should be signed by an administrator, director of nursing, and/or medical director or other physician champion.

This program does not involve human subjects research, so no IRB approval is required. Your facility should be able to frame this program as a quality improvement study. Johns Hopkins Medicine has determined this program is not Human Subjects Research (Johns Hopkins IRB #IRB00129058). If your facility should require an IRB submission for informational purposes, we will be glad to help you as needed.

11. Who is sponsoring the program?
This program is funded and guided by the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services (HHS). The work is being conducted by Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality in collaboration with NORC at the University of Chicago.