Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.
Antibiotic resistance is a threat that just keeps giving.
A recent WHO article on the state of antimicrobial research and drug-resistance suggests that antibiotic research and development is losing ground to superbugs, and projects that unless we increase the rate of antibiotics drug development and reduce the rate of resistance, we face a near future in which many infections will have no “last resort” drug left.
Antibiotic resistance is a multifactorial problem that has causes rooted in agricultural overuse, overprescription, and inappropriate use. Physicians routinely report that patients will demand antibiotics for viral or other conditions, and some patients even become violent when refused antibiotics. On the other side of the equation, some vendors have made over-the-counter antibiotic products such as topical creams and hand-cleaning products.
The following pertinent articles have been provided by Physician’s Weekly: (Please note the CME)
- CME/CE: Guidance on Implementing Antibiotic Stewardship
- CDC Report: Core Elements of Outpatient Antibiotic Stewardship
- New Antibiotic Stewardship Guidelines Focus on Practical Advice for Implementation
- Combating Antibiotic Resistance
- The Perils of Antibiotic Resistance
We will take a QI approach, and discuss the topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.
Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:
- Policies: office, organization, or national policies, including, etc
- Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
- Quality Improvement Policies
- Subsidies and funding
- Facility Policies
- Specialty Policies
- Employment policies
- National and State Laws
- Navigable processes and policies
- Machines (incl equipment, EHR)
- Personal Safety Equipment
- Real Time Locator Systems (RTLS)
- Med Equipment
- Equip Ergonomics
- Home Equipment
- Access Control
- Office Equipment
- Product tracking
- Staffing: sufficient and qualified staff
- Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
- Subject Experts
- Malpractice suits
- Role Models
- Peer support/conflict
- Crime and safety
- Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
- Supplies: medical or office, inferior fax paper,
- Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
- Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
- Internet sources and access
- Checklists, SoPs
- Uniforms, footwear, personal protective equipment
- Costed consumables
- OTC products containing antibiotics
- Health outcomes
- KPIs: operational metrics required by practice, local government, state, federal
- Quality and safety metrics
- Targets: set by practice, insurer, etc. as well as patient goals
- Gini Index
- Incentives and rewards
- Adverse Eventss reporting
- Effectiveness of measurement
- Productivity Metrics
- Patient Goals
- Noise: distracting noises, sound levels too high, etc. due to computer systems
- Space: Cramped, uncomfortable work space etc.
- Time: Too little time per patient or order, too little time in a day, too many demands
- Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
- Control: the degree to which the individual can control their workload and how to accomplish it
- Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
- Temperature: too cold, too hot, too variable
- Political climate
- Social norms and group identity
- Electrical Power
- Climate and weather
- Income inequality
- Potable water
- Direct marketing to patients
Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.
- What METHODS increase or reduce risks related to Antibiotic Resistance
- What MACHINE factors increase or reduce risks related to Antibiotic Resistance
- What PEOPLE issues increase or reduce risks related to Antibiotic Resistance
- What MATERIALS increase or reduce risks related to Antibiotic Resistance
- What MEASUREMENT factors increase or reduce risks related to Antibiotic Resistance
- What ENVIRONMENTAL factors increase or reduce risks related to Antibiotic Resistance
MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.
To quote the IHI on what the Triple Aim encompasses:
The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:
- Improving the patient experience of care (including quality and satisfaction);
- Improving the health of populations; and
- Reducing the per capita cost of health care.
The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.
The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.