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Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

Published online by Cambridge University Press:  19 February 2021

Joanne Huang ,
Zahra Kassamali Escobar ,
Todd S. Bouchard ,
Jose Mari G. Lansang ,
Rupali Jain ,
Jeannie D. Chan ,
John B. Lynch ,
Marisa A. D’Angeli ,
Larissa S. May  and
Chloe Bryson-Cahn
Joanne Huang
Affiliation:
University of Washington Medicine, University of Washington Medical Center, Seattle, Washington University of Washington School of Pharmacy, Seattle, Washington
Zahra Kassamali Escobar
Affiliation:
University of Washington School of Pharmacy, Seattle, Washington University of Washington Medicine, Valley Medical Center, Renton, Washington
Todd S. Bouchard
Affiliation:
University of Washington Medicine, Valley Medical Center, Renton, Washington
Jose Mari G. Lansang
Affiliation:
University of Washington Medicine, Valley Medical Center, Renton, Washington
Rupali Jain
Affiliation:
University of Washington Medicine, University of Washington Medical Center, Seattle, Washington University of Washington School of Pharmacy, Seattle, Washington
Jeannie D. Chan
Affiliation:
University of Washington School of Pharmacy, Seattle, Washington University of Washington Medicine, Harborview Medical Center, Seattle, Washington
John B. Lynch
Affiliation:
University of Washington Medicine, Harborview Medical Center, Seattle, Washington Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington
Marisa A. D’Angeli
Affiliation:
Washington State Department of Health, Healthcare Associated Infections Program, Shoreline, Washington
Larissa S. May
Affiliation:
Department of Emergency Medicine, University of California-Davis Health, Sacramento, California
Chloe Bryson-Cahn*
Affiliation:
University of Washington Medicine, Harborview Medical Center, Seattle, Washington Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington
*
Author for correspondence: Chloe Bryson-Cahn, Harborview Medical Center, 325 Ninth Avenue, Box 359778, Seattle, WA 98104. E-mail: chloebc@uw.edu
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Abstract

The MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.

Type
Concise Communication
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 11 , November 2021 , pp. 1376 - 1378
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Antibiotic use in the United States, 2018 update: progress and opportunities. Centers for Disease Control and Prevention website https://www.cdc.gov/antibiotic-use/stewardship-report/pdf/stewardship-report-2018-508.pdf. Published 2019. Accessed December 16, 2020.Google Scholar
Palms, DL, Hicks, LA, Bartoces, M, et al. Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States. JAMA Intern Med 2018;178:1267–1269.CrossRefGoogle ScholarPubMed
Jaworski, M, McGrath, K, Parsons, P, et al. Qualis Health antimicrobial stewardship in outpatient settings—Valley Medical Center/UW Medicine. 2018. Accessed June 25, 2020.Google Scholar
May, L, Yadav, K, Gaona, SD, et al. MITIGATE antimicrobial stewardship toolkit. Society for Healthcare Epidemiology of America website. http://www.shea-online.org/images/priority-topics/MITIGATE_TOOLKIT_final.pdf. Published 2018. Accessed December 15, 2020.Google Scholar
Fleming-Dutra, KE, King, LM, Boghani, S, Hicks, L, Hou, J, Kirkham, HS. 969. Antibiotic prescribing in a large retail health clinic chain: opportunities for stewardship. Open Forum Infect Dis 2019;6 suppl 2:S32–S33.10.1093/ofid/ofz359.071CrossRefGoogle Scholar
Choosing Wisely Claims-Based Technical Specifications V1.1. Washington State Choosing Wisely Task Force website. https://wahealthalliance.org/wp-content/uploads/2013/11/Choosing_Wisely_Specifications_2014.pdf. Published 2014. Accessed December 15, 2020.Google Scholar
Ranji, SR, Steinman, MA, Shojania, KG, et al. Antibiotic prescribing behavior, vol. 4. In: Shojania, KG, McDonald KM, Wachter RM, Owens DK, editors. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Technical Review 9. AHRQ Publication No. 04(06)-0051-4. Rockville, MD: Agency for Healthcare Research and Quality; 2006.Google Scholar
Meeker, D, Knight, T, Friedberg, MW, Linder, JA, Goldstein, NJ, Fox, CR, et al. Nudging guideline-concordant antibiotic prescribing a randomized clinical trial. JAMA 2014;174:425–431.Google ScholarPubMed
Yadav, K, Meeker, D, Mistry, RD, et al. A multifaceted intervention improves prescribing for acute respiratory infection for adults and children in emergency department and urgent care settings. Acad Emerg Med 2019;26:719–731.CrossRefGoogle ScholarPubMed
Cummings, P, Alajajian, R, May, L, et al. Utilizing behavioral science to improve antibiotic prescribing in rural urgent care settings. Open Forum Infect Dis 2020;7(7):ofaa174.10.1093/ofid/ofaa174CrossRefGoogle ScholarPubMed
Barden, LS, Dowell, SF, Schwartz, B, Lackey, C. Current attitudes regarding use of antimicrobial agents: results from physician’s and parents’ focus group discussions. Clin Pediatr (Phila) 1998;37:665–671.10.1177/000992289803701104CrossRefGoogle ScholarPubMed
Sanchez, GV,Roberts, RM, Albert, AP, Johnson, DD, Hicks, LA. Effects of knowledge, attitudes, and practices of primary care providers on antibiotic selection, United States. Emerg Infect Dis 2014;20:2041–2047.CrossRefGoogle ScholarPubMed
Martinez, KA, Rood, M, Jhangiani, N, Kou, L, Boissy, A, Rothberg, MB. Association between antibiotic prescribing for respiratory tract infections and patient satisfaction in direct-to-consumer telemedicine. JAMA Intern Med 2018;178:1558–1560.10.1001/jamainternmed.2018.4318CrossRefGoogle ScholarPubMed
Dialogue around respiratory illness treatment. Interactive Medical Training Resources website. https://www.uwimtr.org/dart/. Accessed July 7, 2020.Google Scholar
Kassamali Escobar, Z, Bouchard, T, Lansang, JM, et al. Initial impact of COVID-19 on ambulatory antibiotic prescribing for respiratory viral infections. Presentation 143 at the IDWeek virtual conference, October 22–25, 2020.10.1093/ofid/ofaa439.188CrossRefGoogle Scholar