Over the last few months, the CDC, the White House and numerous agencies such as The Joint Commission have issued statements and recommendations about two growing threats that are certain to become national health crises unless providers take definitive action now: antibiotic resistance and opioid misuse. The data behind these concerns is compelling. According to the CDC,
- Each year in the U.S. at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections
- Opiate analgesics consistently rank among the top drug classes associated with adverse drug events. Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.
While statements and recommendations help raise public awareness, developing plans to manage these issues in hospitals and their communities are generally left to the physicians, nurses and pharmacists working on the front lines.
To support this work and speed implementation of appropriate stewardship programs, Vizient members have been taking part in available pharmacy collaboratives for antibiotics and opioids.
Performance improvement (PI) collaboratives are an intensive approach which unites and focuses members of all sizes, from across an organization, on a single issue. Participants meet on a recurring basis to collaborate by sharing experiences, data and insights that ultimately lead to individual strategies to deal with the identified issue, said Jim Lichauer, project manager, PI collaboratives and advisory, pharmacy.
At the conclusion of each collaborative, a “knowledge transfer” webinar is scheduled and open to members of the Vizient PI collaboratives program. The knowledge transfer webinar is a detailed report out of the collaborative’s activities, findings, lessons learned and outcomes. A Knowledge Transfer Collaborative Final Report summarizing the work is available for PI collaborative program members not participating in the collaborative project.
Antimicrobial Stewardship Improvement Collaborative
The Antimicrobial Stewardship Improvement (AMS) Collaborative, which just concluded in early October, focused on topics that were central to the work of the hospital engagement network (HEN): reducing harm associated with the delivery of care and establishing AMS programs in hospitals. These topics were fairly broad and participants worked on projects they felt best fit their organizations.
As we look ahead to 2017, the AMS Collaborative will again be aligned with the Hospital Improvement Innovation Network (HIIN). For this HIIN the AMS scope will be narrower with a strong focus on C. difficile rates and multidrug-resistant organisms. “We expect there will be many organizations that carry over from the previous HEN to the new HIIN, so we’re trying to structure the collaborative in a way that enables them to build on previous work relevant to their individual facilities,” said Lichauer.
Adverse Drug Event Improvement Collaborative
The Adverse Drug Event Improvement (ADE) Collaborative, which kicked off this week, will focus on how the improper and widespread use of opioid analgesics has led to a national epidemic of opioid overdose deaths and addictions. Participants will be able to select an area of opportunity within opioid prescribing that aligns with CDC recommendations:
- Determining when to initiate or continue opioids for chronic pain
- Opioid selection, dosage, duration, follow up and discontinuation
- Assessing risk and addressing harms of opioid use
“We created the ADE Collaborative to help members understand, implement and sustain best-practice recommendations that improve opioid stewardship and subsequent adverse events,” said Lichauer.
While this specific ADE Collaborative has already launched, Vizient has been partnering with members for the past several months on a global opioid stewardship campaign to learn more about this issue from national leaders, share best practices and continue various efforts to help members improve together. If you are interested in the Vizient portfolio opioid stewardship campaign, check out the resources and work completed to date here. For members who belong to the PI collaborative program, specific results on the Adverse Drug Event Collaborative – Prescribing Opioids for Chronic Pain, will be featured through a knowledge transfer webinar in the summer of 2017.
A closer look at collaboratives
A typical collaborative – there are about 12 running per year – lasts nine months and includes a mix of monthly conference calls and webinars. The first few months of a collaborative focus on information gathering and giving members time to analyze the issue at hand, create a team and put a project charter together. The next phase involves implementation of the identified practices, data monitoring and analysis to achieve the desired result.
Collaboratives include members from both academic medical centers and community hospitals of all sizes. “They can be made up of very diverse groups with a lot of different needs. But no matter the size, participants will benefit from the sharing of information.”
As the name implies, the high level of collaboration is what really makes collaboratives stand out with members. For the AMS Collaborative, for example, pharmacists served as project liaisons working with member physicians, nurses and pharmacists. “We often include leading high-level experts serving as subject matter experts so everyone can benefit,” said Lichauer.
Topics are decided in a variety of ways. In the case of the AMS Collaborative, it was driven by members seeking answers in the wake of CDC recommendations issued earlier this year that featured tips and focus areas for prescribing practices in primary care clinics.
“Our collaboratives are member driven, so the focus is on getting member feedback and providing them with what they need. We want our collaboratives to offer member value,” Lichauer said. “For me, that means using these programs to engage members with the important information they can implement in their settings.”
Planning is currently underway for a new series of pharmacy-focused collaboratives that could include topics such as medication management from acute care to ambulatory care, medications around anticoagulants and specialty pharmacy medications.
For more information about all PI collaboratives at Vizient, contact Laural Whitmore.