HHS, AHRQ, HAI, and CUSP
1. What are the benefits of participating?
2. What is antibiotic stewardship?
3. Who is sponsoring the project?
4. Is there a maximum number of hospitals that can participate?
5. What is the timeline of the project?
6. What does it cost our facility to participate in the project?
7. How much time will the program take per month?
8. What is your definition of “unit” for the Safety Program? Should I pick a particular unit to target or the entire hospital?
9. Will CME or other continuing education credits be provided for any of the webinars?
10. Is a contract required to participate in the project?
11. What material do I need to complete before the kickoff?
12. Are the monthly webinars more about antibiotic stewardship or clinical instruction for management of infectious diseases?
13. Who is required to participate in the webinars? Will staff be able to participate in the monthly sessions if they are not part of the chosen participating unit?
14. How long does it take for the webinar recordings to be placed on the website?
15. Does the AHRQ Safety Program for Improving Antibiotic Use employ the Comprehensive Unit-based Safety Program (CUSP)?
16. Who is eligible to participate?
17. Is the program targeting specific types of hospitals? Can critical access hospitals participate?
18. Can facilities participate without a single designated antibiotic stewardship leader?
19. My organization does not currently have an electronic health record (EHR). Are we still eligible to apply for the program?
20. Can pediatric units participate?
21. What is required of our facility in order to participate in the project?
22. Our facility does not have an antibiotic stewardship program (ASP). Can we still participate?
23. Is it okay to have multiple programs running simultaneously? How does this program align with the Centers for Medicare & Medicaid Services (CMS) Hospital Improvement Innovation Network (HIIN) program?
24. Can an inpatient behavioral health facility or an acute psychiatric and residential drug and alcohol center participate?
25. Our hospital service is spread over many units. Is it possible to participate with service areas rather than units?
26. What will the data be used for?
27. What data are being collected?
28. Are we required to submit data to NHSN? Will we need to use the NHSN AUR data metric?
29. Can you pull our antibiotic use and C. difficile data from NHSN for a facility?
30. If we choose a unit or physician group to join, would we need to submit antibiotic use and C. difficile data for that unit specifically?
31. Where specifically will our data be shared, and will it be “published” with our hospital identifiers?
32. What is in the Team Antibiotic Review Form that needs to be submitted?
33. Does the data need to be submitted in specific format? Is this a file-based upload?
34. Will participants have to provide protected health information (PHI) about their patients?

General Program Overview

1. What are the benefits of participating?

Our antibiotic stewardship team will work closely with members of your hospital to develop or enhance your antibiotic stewardship program and activities. Using evidence-based, scientific literature, coupled with practical implementation strategies, we will help your team to understand the drivers of antibiotic prescribing, improve knowledge of antibiotic use for common infectious disease syndromes, and identify approaches to optimize antibiotic use. Our team has expertise in antibiotic stewardship and quality improvement and will be readily accessible for coaching, technical assistance, and ongoing education. Participation in this project will assist with compliance with The Joint Commission’s Antimicrobial Stewardship Standard. Other benefits of participation include:

  • Improving safety culture in facilities and practices
  • Enhancing teamwork and communication between health care workers and between healthcare workers and patients/families
  • Reducing unnecessary antibiotic use
  • Improving antibiotic decision-making by frontline staff
  • Reducing Clostridium difficile infection rates
  • Providing regular access to experts in antibiotic stewardship and quality improvement
  • Improving compliance with The Joint Commission requirements
  • Earning 15 credit hours of CMEs for physicians or CEs for pharmacists by participating in 15 educational webinars.
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2. What is antibiotic stewardship?

Antibiotics decrease morbidity and mortality when used appropriately, but overuse of antibiotics contributes to both the increasing rate of Clostridium difficile infections (CDI) and the emergence of antibiotic resistance. Antibiotic stewardship (AS) 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.

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3. Who is sponsoring the project?

This project 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 University in collaboration with NORC at the University of Chicago.

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4. Is there a maximum number of hospitals that can participate?

Up to 500 hospitals will be able to participate.

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5. What is the timeline of the project?

This project asks for a one-year commitment to improve the outcomes for patients receiving antibiotics.
Onboarding/orientation webinars for the project will begin in December 2017. Data collection will begin in January 2018.
Action Due Date
Assemble a multidisciplinary team within your hospital unit November 17, 2017
Complete the Hospital Letter of Commitment
Register your team to use the project data portal
Participate in educational programs including the onboarding/ orientation webinar series, eLearning Modules and content webinars Beginning December 2017
Regularly meet as a team to implement interventions and monitor performance January 1, 2018 until end of project
Complete survey assessments and submit hospital unit data according to the data collection schedule

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6. What does it cost our facility to participate in the project?

Participation in the program is free. Participating facilities will not incur any fees to receive facilitation as a part of this project and will not receive any payment for their participation. Of note, The Joint Commission has an Antimicrobial Stewardship standard effective January 2017 that requires that all hospitals have antibiotic stewardship programs. Participation in the project will assist with compliance with the Joint Commission’s Antimicrobial Stewardship Standard.

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7. How much time will the program take per month?

We anticipate that participants will spend a minimum of 4 hours per month on the AHRQ Safety Program for Improving Antibiotic Use. Approximately two hours will be devoted to participating in webinars. The remaining two hours will be spent having team meetings to discuss specific antibiotic-related issues and to complete Team Antibiotic Review forms. In addition, frontline teams/providers are expected to incorporate review of antibiotics in their daily workflow. There are two additional hours of optional coaching calls that sites can participate on if they need additional assistance to improve their antibiotic use.

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8. What is your definition of “unit” for the Safety Program? Should I pick a particular unit to target or the entire hospital?

For this project, a unit is an area with defined and consistent staff who care for patients. In the acute care setting it can be a clinical unit or clinical service. Individual units (e.g., MICU, general medical ward) or clinical services (e.g., hospitalist service) or entire hospitals are welcome to participate. There is also no limit to the number of participating units within an institution. Hospitals are encouraged to enroll individual units or an entire hospital.

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9. Will CME or other continuing education credits be provided for any of the webinars?

Yes. Credit will be offered for attending each of the 15 educational webinars that will be held during the 12-month program. The Society for Healthcare Epidemiology of America is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Society for Healthcare Epidemiology of America designates this live activity for a maximum of 15 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. We have also applied for CEs for pharmacists.

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10. Is a contract required to participate in the project?

No, a contract is not required to participate in the project. We will ask your facility’s primary contact for the project and the facility administrator to complete an application. We also need a letter of commitment signed by an administrator, physician, pharmacist, and nursing/quality lead (if present at your facility). This is not a contract; rather, it is an agreement to work with us.

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11. What material do I need to complete before the kickoff?

You will need to complete the online application and a letter of commitment. 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 University has received national IRB approval as 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.

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12. Are the monthly webinars more about antibiotic stewardship or clinical instruction for management of infectious diseases?

The monthly webinars focus on 1) how to establish and/or maintain a well-functioning and successful antibiotic stewardship program; 2) how to improve communication between stewardship staff and front line staff as well as behaviors and attitudes related to antibiotic prescribing; and 3) discussions of best practices for common inpatient infectious syndromes (e.g., community-associated pneumonia, ventilator-associated pneumonia, urinary tract infections, etc.).

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13. Who is required to participate in the webinars? Will staff be able to participate in the monthly sessions if they are not part of the chosen participating unit?

The stewardship physician and pharmacist should participate in the monthly webinars. Clinical staff on participating units should participate in the webinars; this includes all individuals who are responsible for ordering, administering, or monitoring the use of antibiotics including physicians, pharmacists, nurses, nurse practitioners, and physician assistants. We recognize that not all frontline clinical staff can be on each webinar due to clinical responsibilities; thus, we recommend that units designate at least one or two frontline providers to attend each webinar in real time and report back to the rest of the team on the topic covered. In addition, the slides and accompanying facilitator guides for all webinars will be available on the program website for staff who are unable to be on the live webinars. All participating staff will be provided with a user name and password to access the project website which contains all educational content related to the project.

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14. How long does it take for the webinar recordings to be placed on the website?

Recordings of the webinars are placed on the website within a week after the webinar takes place.

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15. Does the AHRQ Safety Program for Improving Antibiotic Use employ the Comprehensive Unit-based Safety Program (CUSP)?

The AHRQ Safety Program for Improving Antibiotic Use uses the framework and methods of CUSP, but adapts them to address improving antibiotic prescribing. CUSP is a customizable quality management program that promotes communication, teamwork, and leadership engagement to support a culture of patient safety. It combines clinical best practices with systems improvements to patient safety culture.

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Eligibility

16. Who is eligible to participate?

All acute care hospitals are invited to participate. Although entire hospitals are encouraged to participate, individual units or clinical services can still participate.

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17. Is the program targeting specific types of hospitals? Can critical access hospitals participate?

The program is targeting a wide variety of acute care hospitals of all different sizes. Critical access hospitals can participate. We request that if a stewardship program is not already present in a facility that is interested in participating, a physician and/or, a pharmacist) are identified to be willing to be trained to become antibiotic stewardship leads through the AHRQ Safety Program for Improving Antibiotic Use. In addition, you will need to provide antibiotic use data (days of antibiotic therapy per 1,000 patient-days) and complete the required Team Antibiotic Review Form.

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18. Can facilities participate without a single designated antibiotic stewardship leader?

For this program to be successful, each facility needs to have a leader, even if the individual is not trained in infectious disease. The program prefers a physician and/or pharmacist to be the stewardship leads.

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19. My organization does not currently have an electronic health record (EHR). Are we still eligible to apply for the program?

Yes, facilities that do not have electronic health records are also encouraged to apply. If your facility does not have an electronic health record, we are happy to discuss ways we can work with your organization to collect data.

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20. Can pediatric units participate?

Pediatric units are welcome to participate. The adaptive and technical content that have been developed is applicable to both children and adults.

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21. What is required of our facility in order to participate in the project?

Each site would identify a stewardship team (i.e., physician and/or pharmacist) to assist with overseeing work. Activities include:

  • Participate in regular webinars. Participants will receive training via webinars held one to two times per month.
  • Determine and implement approaches to improve antibiotic use on the participating units. Using approaches discussed in the webinars, frontline teams will work with the local stewardship teams to develop and implement approaches to review patients who are receiving antibiotics on a daily basis and optimize antibiotic therapy. In addition, teams will participate in assessing issues with how antibiotics are prescribed and administered on their unit and developing improvement plans.
  • Collect and review data. Your stewardship team and frontline staff is encouraged to work together to review data on at least 10 patients receiving antibiotics on a monthly basis to determine if antibiotic use was appropriate and to identify opportunities for improvement. We will use data submitted from your existing electronic health record to collect monthly data on days of antibiotic therapy per 1,000 patient days and rates of Clostridium difficile infection. (We will also accept data on days of antibiotic therapy per 1,000 day present, or the AUR) module, if you are already collecting this data or this approach works better for your facility.
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22. Our facility does not have an antibiotic stewardship program (ASP). Can we still participate?

Yes. If an ASP is not present, we will work with clinicians who are interested in learning the principles of antibiotic stewardship to train them to become antibiotic stewards and create this expertise within your own organization. However, these antibiotic stewards must implement the interventions on at least one unit.

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23. Is it okay to have multiple programs running simultaneously? How does this program align with the Centers for Medicare & Medicaid Services (CMS) Hospital Improvement Innovation Network (HIIN) program?

If you have other initiatives occurring in your facility, you can still participate. We encourage other stewardships at the same time. We ask participating units to complete a 1 page structural assessment at the beginning and end of the project and mention of other antibiotic stewardship-related initiatives would be helpful.

This AHRQ Safety Program for Improving Antibiotic Use is complementary to the Hospital Improvement Innovation Network (HIIN) program. One of the HIIN core topics is reduction in Clostridium difficile infections. One of the goals of the AHRQ Safety Program is to decrease Clostridium difficile infections. Hospitals can elect to participate in both the HIIN and AHRQ programs, and participation in the AHRQ program may help hospitals reach HIIN goals

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24. Can an inpatient behavioral health facility or an acute psychiatric and residential drug and alcohol center participate?

You can participate in the program if you can identify antibiotic stewardship leaders (a physician and/or pharmacist), have adequate numbers of patients who are treated with antibiotics during their stays and can provide antibiotic use data (days of antibiotic therapy per 1,000 patient-days). Along with building teamwork around antibiotic prescribing, we are focusing on how to appropriately treat patients who have symptoms of several different syndromes common to an acute care hospital. These include asymptomatic bacteriuria, urinary tract infections, community-acquired lower respiratory tract conditions, healthcare-associated and ventilator-associated pneumonia, skin and soft tissue infections, intra-abdominal infections, and Clostridium difficile infections; please consider if this will be relevant to your patient population when making the decision to participate.

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25. Our hospital service is spread over many units. Is it possible to participate with service areas rather than units?

Yes. Both clinical services and units are welcome to participate.

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Data Collection

26. What will the data be used for?

The data are being collected both for program evaluation purposes and as a tool for each site’s own quality improvement efforts. Each site should use the data they collect to evaluate their antibiotic use and antibiotic stewardship efforts. NORC at the University of Chicago and Johns Hopkins University will use the collected data to evaluate the adoption and effectiveness of the program overall. Additionally, each site can compare its antibiotic use to similar facilities. The program is collecting only de-identified data. Aggregate hospital antibiotic use data will be shared with similar participating hospitals for comparison purposes only. Individual participating hospitals will not be identified.

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27. What data are being collected?

Please see the table below.

Data Collection Tools
Tool Purpose Frequency of Data Collection To Be Completed by Estimated Completion Time
Structural Assessment tool To collect facility-level information, including existing stewardship infrastructure At the beginning and the end of the program Unit leaders Approximately 10 minutes per form
Hospital Survey on Patient Safety (HSOPS) To collect information on patient safety issues, unit culture, medical errors, and event reporting At the beginning and end of the program All unit staff 30 minutes per survey
Team Antibiotic Review Form` To provide information on whether the program is associated with improved antibiotic decision making by participating clinicians 10 forms per month per unit Stewardship team with input from frontline staff Between 5-15 minutes per form
EHR Clinical Data Extracts
Tool Purpose To Be Completed by Estimated Completion Time
Days of antibiotic therapy (DOT) per 1,000 patient-days* To evaluate the changes in antibiotic usage, clinical outcomes, and other effectiveness measures Extracted from Electronic Health Record (EHR). See below for more information. 60 minutes per quarter. May vary, depending on hospital IT/data collection infrastructure.
Clostridium difficile laboratory- (LabID) events per 10,000 patient-days by unit Extracted from EHR

*For more information on the DOT per 1,000 patient-days measure, please see below.
DOT per 1,000 patient-days measure
Numerator: We are requesting days of antibiotic therapy for commonly used inpatient antibiotics. Antibiotic administration or ordering data is acceptable for the numerator, but not purchasing data.
Denominator: We are requesting patient days. This denominator may be familiar to many hospitals from their facility’s infection control work and may already be calculated on a monthly basis. It represents the number of patients on a unit for each day of the month.
PLEASE NOTE: DOT per 1,000 patient-days is different from the NHSN Antimicrobial Use and Resistance metric. You do not need to submit data to the NHSN AUR to participate in this project. If you are an institution that submits NHSN AUR data and would prefer to submit that same data to our project website, that is also acceptable.
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28. Are we required to submit data to NHSN? Will we need to use the NHSN AUR data metric?

There is no requirement to submit data to NHSN. We are not asking for data using the NHSN AUR data metric. However, if you already submit data to NHSN’s AUR Module and obtaining the data for days of antibiotic therapy per 1,000 patient days is difficult, you may submit this data.

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29. Can you pull our antibiotic use and C. difficile data from NHSN for a facility?

Although we will accept antibiotic use data using the NHSN AUR numerator and denominator, we are not requesting you to confer rights for the NHSN data, and we will not be able to retrieve your facility’s data by this mechanism. We will require that you separately submit both your days of therapy and C. difficile data to the NORC/JHU team.

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30. If we choose a unit or physician group to join, would we need to submit antibiotic use and C. difficile data for that unit specifically?

Participating hospitals should submit unit or clinical service-specific data and not hospital-wide data. However, if your institution is already reporting this data for another similar entity (e.g., the entire unit including multiple services), submitting those DOT and C. difficile rates would be acceptable, provided they also encompass the specific service. If your team is a hospitalist team, for example, that works in several different units, it would be best to submit data for all the involved units. If the hospitalist team covers a step down unit and two medicine units, submit data for all three floors individually.

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31. Where specifically will our data be shared, and will it be “published” with our hospital identifiers?

We’re only collecting de-identified data. Your data will be aggregated, anonymized, and then shared with AHRQ and other hospitals participating in the project. Hospital antibiotic use data will be shared with other similar participating hospitals for comparison purposes only, and individual hospitals will remain anonymous.

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32. What is in the Team Antibiotic Review Form that needs to be submitted?

The Team Antibiotic Review forms provide a format for teams to review antibiotic use to determine if there is room for improvement for antibiotic decision-making for patients actively receiving antibiotics. We anticipate that stewardship teams will meet with frontline staff and review 10 patients per month. This can be done in one meeting or can be divided between multiple meetings. It should take approximately 5 minutes to complete the Team Antibiotic Review Form per patient. The form is available on the project website. We are not requesting any protected health information (PHI) on this form. The main purpose of the form is to generate discussion regarding antibiotics decisions for patients actively receiving antibiotic therapy. The goal is to emphasize the use of the four moments of antibiotic decision making as described in the webinars and to discuss targets for improved antibiotic prescribing as a team.

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33. Does the data need to be submitted in specific format? Is this a file-based upload?

The Team Antibiotic Review Forms can be uploaded electronically to the project website. Similarly, antibiotic use data and C. difficile data can be uploaded electronically to the website. As an example, if your institution is able to generate antibiotic use data in an Excel file, the Excel file can be directly uploaded to the project website. Information on data submission is available on the program website and the project team can individually discuss with you the most feasible submission process for your facility.

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34. Will participants have to provide protected health information (PHI) about their patients?

The program is not requesting any PHI.

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