Massachusetts Coalition for the Prevention of Medical Errors

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Initiatives:

Healthcare Associated Infections

Improving Evaluation of Urinary Tract Infections in the Elderly:
Collaborative on Antibiotic Stewardship for Seniors in Long Term Care

The focus of these 2 Collaboratives was to reduce the inappropriate use of antibiotics. Faculty coached clinical staff in long term care facilities and hospital emergency departments to:

Improve evaluation and treatment of urinary tract infection.
Decrease treatment for asymptomatic bacteriuria.
Use clinical quality improvement tools for decision support.
Communicate with patients and their loved ones for safer care.

This page provides access to:

Quality improvement tools for clinicians
Brochures, newsletters and articles aimed at educating seniors and their families
Webinars, workshops and slide sets used to teach nurses, doctors, and staff from nursing homes and acute care hospital Emergency Departments about providing improved assessment and care for the elderly across the continuum.

Tools and Programs to Reduce the Overuse of Antibiotics for Seniors

Webinars for Clinicians:

Overview of our Quality Improvement Collaborative to Improve Antibiotic Stewardship through Evaluation of UTI in the Elderly
Appropriate Evaluation of UTI vs Asymptomatic Bacteriuria
Evaluating Altered Mental Status in Elderly Long Term Care Residents

Practice Support & Education Tools for Clinicians in LTC

Education Tools for Seniors, LTC Residents, and their Families

Tools for Hospital Emergency Departments

For Consumers, including Seniors, LTC Residents, and their Families

Collaborative Workshops

Kickoff Workshop
Regional Meetings
Final Workshop
Collaborative Workshops (2012 – 2013)

Webinars for Clinicians
Improving Infection Prevention and Antibiotic Stewardship through Quality Improvement Collaboratives: Tales from Two Successful Facilities Susanne Salem-Schatz, ScD Collaborative Director Massachusetts Coalition for the Prevention of Medical Errors Laurie Herndon, MSN, GNP-BC Director of Clinical Quality Massachusetts Senior Care Foundation Melanie Brace, RN Director of Nursing Hancock Park Rehabilitation and Nursing Center, Quincy, MA Sister Katherine Theresa Twitchell, APRN-BC, ANP Infection Control Marian Manor, Boston, MA Watch the webinar Slide set only	AIM: Step-by-step methods to reduce the overuse of antibiotics and improve antibiotic stewardship in long-term care. How to identify clinical aims, tools and strategies to improve quality and safety Using process data to identify the source and scope of the problem Engaging staff to participate How to identify and overcome barriers
Appropriate Evaluation of UTI in the Elderly Shira Doron, MD Associate Hospital Epidemiologist Division of Geographic Medicine and Infectious Diseases Tufts Medical Center Associate Professor of Medicine Tufts University School of Medicine Ruth Kandel, MD Director, Infection Control Hebrew Senior Life Assistant Professor Harvard Medical School Watch the webinar Download the slide set (split into 2 files): Slide set part 1 Slide set part 2	AIM: Various strategies to learn the difference between asymptomatic bacteriuria and true signs and symptoms of UTI. Antibiotic stewardship Risks of antibiotic use UTI treatment choices Definition and prevalence of asymptomatic bacteriuria Guidelines for when to test and treat suspected UTI UTI treatment choices
Evaluating Altered Mental Status in Elderly Long Term Care Residents Ruth Kandel, MD Director, Infection Control Hebrew Senior Life Assistant Professor Harvard Medical School Laurie Herndon, GNP MSN, GNP-BC Director of Clinical Quality Watch the webinar Slide set only	AIM: Review of various reasons for altered mental status, in residents with and without dementia The difference between dementia and delirium How you and your staff can develop critical thinking in this important area Useful tools to support evaluation of altered mental status from this program and the INTERACT initiative
Practice Support & Education Tools for Clinicians in LTC
UTI Protocol: ABCs for Diagnosing Urinary Tract Infection in Long Term Care PDF version Word version	A checklist-based worksheet to guide decisions and communication about testing urine and treating UTIs in long term care.
Clinician education sheet: long term care facility	Key issues on testing and treatment of suspected UTI in long term care facilities. Print-ready: for larger text size choose legal.
Data Collection Workbook: long term care	Excel workbook for project data collection; creates monthly run charts
Quality Improvement Tool For Review of Acute Care Transfers (from the INTERACT Version 3.0 Tools)	Guides staff through root cause analyses of acute care transfers to understand factors that contribute to transfers and help identify opportunities for improvement.
Discovery and Action Handbook Note:This handbook can be opened in Adobe Acrobat Reader and its 4 pages printed on both sides. To Print: Under Printer Properties, “ Print on Both Sides?” choose “ Yes, Flip Up.” Or “ Flip on Short Edge.” The pages assemble together into a booklet.	This handbook offers ways to open dialogue with staff, engage everyone to generate and discover ideas, and collaborate dynamically to solve problems.
Mnemonic poster for assessing change in mental status	This single sheet uses the acronym DELIRIUMS as a reminder of the many potential causes for altered mental status in the residential elderly.
AMDA “Choosing Wisely” Recommendations Five Things Physicians and Patients Should Question	From the American Medical Directors Association. #3 Don’t obtain a urine culture unless there are clear signs and symptoms that localize to the urinary tract.
AGS “Choosing Wisely” Recommendations Five Things Physicians and Patients Should Question	From the American Geriatric Society #5 Don't use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.
Talking with families about UTIs, Bacteriuria & Antibiotics: slides for a family/resident council meeting Irene Campbell, GNP St. Patrick’s Manor Framingham, MA	A slide presentation that provides an understanding of the science of UTI. Including practical tips on communicating with families and residents about the dangers of unnecessary antibiotic use.
Education Tools for Seniors, LTC Residents, and their Families
“Suspect a Urinary Tract Infection? How Taking Antibiotics When You Don't Need Them Can Cause More Harm Than Good” Brochure View online PDF version for printing Newsletter Format Word version	To help seniors and their families learn about the hazards of overuse of antibiotics, which is common when UTI is suspected.
Facility Newsletter Article “Are We SURE It Is a Urinary Tract Infection? Partnering for Better Care” Newsletter Format Word version	This article was written to help facilities in the Collaborative to communicate with residents and their families about appropriate assessment for UTI. Facilities can customize and send as a newsletter or mailing insert to residents‘ families.
“When Do You Need An Antibiotic?” Brochure PDF version for printing Supplemental Insert “Urinary Tract Infections And Asymptomatic Bacteriuria in Long Term Care Residents”	A brochure to support conversations with long-term care facility residents and their families to avoid harm from unnecessary use of antibiotics. Additional details focused on diagnosis and treatment of UTI.
Consumer Reports Health and the American Geriatric Society “Choosing Wisely” Recommendation	2-page handout “Antibiotics for urinary tract infections in older people: When you need them — and when you don’t.”
Tools for Hospital Emergency Departments
WEBINAR: Decreasing Misdiagnosis of UTI in the Emergency Department Daniel J. Pallin, MD, MPH Director of Research, Chairman, Clinical Investigation Committee Brigham and Women’s Hospital Department of Emergency Medicine Assistant Professor, Medicine and Pediatrics Harvard Medical School Shira Doron, MD Associate Hospital Epidemiologist Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center Associate Professor of Medicine Tufts University School of Medicine Watch the Webinar Slide set only	Presentation from ED/Hospital Webinar Targets decision-making and practice in the emergency department Current state of antibiotic resistance crisis The challenge of asymptomatic bacteriuria and the misdiagnosis of UTI Urine testing and collection guidance
Clinician education sheet: Emergency Department version	Key issues on testing and treatment of suspected UTI for long term care facility residents receiving care in hospital Emergency Departments. Print-ready: for larger text size choose legal.
“When Do You Need An Antibiotic?” Emergency Department version PDF version (Brochure)	A brochure to support conversations about unnecessary use of antibiotics, for long-term care facility residents being treated in hospital emergency departments.
Data Collection Workbook: Emergency Department	Excel workbook for project data collection; creates monthly run charts
For Consumers, Including Seniors, LTC Residents, and Their Families
“Suspect a Urinary Tract Infection? How Taking Antibiotics When You Don't Need Them Can Cause More Harm Than Good” Brochure View online PDF version for printing Newsletter Format Word version	To help seniors and their families learn about the hazards of overuse of antibiotics, which is common when UTI is suspected.
“When Do You Need An Antibiotic?” Brochure PDF version for printing Supplemental Insert “Urinary Tract Infections And Asymptomatic Bacteriuria in Long Term Care Residents”	A brochure to support conversations with long-term care facility residents and their families to avoid harm from unnecessary use of antibiotics. Additional details focused on diagnosis and treatment of UTI.
Antibiotic Use in Nursing Homes	This flyer was introduced during Get Smart About Antibiotics Week, to provide education for seniors, their loved ones, nursing home providers (MDs, NPs, and Pas) and nursing home administrators.
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Collaborative Workshops (2013 – 2014)
Kickoff Workshop (October 2013) Agenda Biographies — Faculty and Speakers Opening Slides – Getting Started The Increasing Threat Of Antibiotic Resistance, Shira Doron, MD, MS, Tufts Medical Center, Associate Hospital Epidemiologist To Treat or Not To Treat, Ruth Kandel, MD, Director, Infection Control, Hebrew SeniorLife Tools to Support Lasting Change Ruth Kandel, MD, Director, Infection Control, Hebrew SeniorLife Susanne Salem-Schatz, Sc.D.,Collaborative Director, Massachusetts Coalition for the Prevention of Medical Errors Laurie Herndon, GNP, Director, Clinical Quality, Massachusetts Senior Care Foundation Change for the Better in Your Facility: Some Helpful Frameworks, Sharon Benjamin, PhD, Organizational Behavior Expert, Plexus Institute and Massachusetts Coalition for the Prevention of Medical Errors Measurement in This Collaborative : The Why, The What and The How Laurie Herndon, GNP, Director of Clinical Quality, Massachusetts Senior Care Foundation, Nora McElroy, MPH, General Epidemiologist, Massachusetts Department of Public Health, Paula Griswold, MS, Massachusetts Coalition for the Prevention of Medical Errors How to Get Good Ideas Used: Lessons from the Farm Sharon Benjamin, PhD, Organizational Behavior Expert, Plexus Institute Susanne Salem-Schatz, Sc.D. Planning Your Next Steps, faculty and teams Appropriate Evaluation of UTI vs Asymptomatic Bacteriuria Webinar (December 2013) Watch the webinar Measurement Coaching and Learning Call (December 2013) Slide set One-hour session where faculty explained measurement and reviewed the tools for collecting, reporting and analyzing data for improvement. Evaluating Altered Mental Status in Elderly Long Term Care Residents Webinar(January 2014) Watch the webinar Supporting Improvement: Tools, Measurement, Engagement and Spread Regional Team Half-Day Workshops (February 2014) Agenda Review of Tools & Strategies Front Line Staff Education and Engagement: Evoking Community Asks and Offers – Exercise in engagement Participants each completed 2 Post-Its Asks: To ask a question, “How do I...” or to ask for help. Offers: To share an idea or solution that worked well in their Facility. Participants then regrouped all the Post-Its, matching Asks with Offers Using Data to Create a Storyboard Reviewed the elements of a Baseball Storyboard Distributed Toolkit Table of Contents Participants were asked to work with their coworkers. Create your Facility Storyboard using your facility data and the Toolkit. Antibiotic Stewardship Across the Continuum of Care Conference Call (March 2014) Agenda Antimicrobial Stewardship in Long Term Care - Shira Doron, MD Making it Work at Bethany Health Care Center - Rohit Jangi, MD Expert coaching and learning from colleagues Faculty Conference Call (April 2014) Dialogue on common challenges and tools for improvement. Final Workshop (June 2014) Agenda Biographies – Faculty and Speakers Collaborative Overview Paula Griswold, MS, Executive Director, Massachusetts Coalition for the Prevention of Medical Errors How Far You Have Come: Learning from Our Experience Susanne Salem-Schatz, ScD, Collaborative Director, Massachusetts Coalition for the Prevention of Medical Errors Using Imagery and Stories for Engagement and Impact: Creating and Telling Your Story Sharon Benjamin, PhD, Organizational Behavior Expert, Plexus Institute Susanne Salem-Schatz, ScD, Collaborative Director, Massachusetts Coalition for the Prevention of Medical Errors The wisdom of crowds Susanne Salem-Schatz, ScD, Collaborative Director Laurie Herndon, MSN, GNP-BC, Director, Clinical Quality, Massachusetts Senior Care Foundation Preparing for QAPI: Quality Assurance and Performance Improvement Mary Tess Crotty, Vice President, Quality, Genesis HealthCare Ask the Experts Ruth Kandel, MD, Director, Infection Control, Hebrew SeniorLife Shira Doron, MD, MS, Tufts Medical Center, Associate Hospital Epidemiologist Susanne Salem-Schatz, ScD, Collaborative Director Mary Tess Crotty, Vice President, Quality, Genesis HealthCare Holding the gains: Tips for Sustaining Improvements Over Time Susanne Salem-Schatz, ScD, Collaborative Director The Increasing Public Health Exigency of Antimicrobial Resistance Alfred DeMaria, Jr., MD, Medical Director, Bureau of Infectious Disease, State Epidemiologist, Massachusetts Department of Public Health Moving Forward: What Now? Susanne Salem-Schatz, ScD, Collaborative Director Paula Griswold, MS, Executive Director, Massachusetts Coalition for the Prevention of Medical Errors Improving Infection Prevention and Antibiotic Stewardship through Quality Improvement Collaboratives: Tales from Two Successful Facilities Webinar (July 2014) Featuring: Melanie Brace, RN, Director of Nursing Hancock Park Rehabilitation and Nursing Center, Quincy, MA Sister Katherine Theresa Twitchell, APRN-BC, ANP, Infection Control Marian Manor, Boston, MA Facilitators: Susanne Salem-Schatz, ScD, Collaborative Director Massachusetts Coalition for the Prevention of Medical Errors Laurie Herndon, MSN, GNP-BC, Director of Clinical Quality Massachusetts Senior Care Foundation Agenda: Practical Strategies to move from Clinical Evidence to Implementation Examples of how to get started and to move forward Collecting, learning from and leveraging your data Facing challenges and getting unstuck Finding champions, leaders, and new adopters Slides only Webinar
Collaborative Workshops (2012 – 2013)
Click here for Previous workshops from 2012 – 2013

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Initiatives:

Healthcare Associated Infections Improving Evaluation of Urinary Tract Infections in the Elderly: Collaborative on Antibiotic Stewardship for Seniors in Long Term Care

Tools and Programs to Reduce the Overuse of Antibiotics for Seniors

Kickoff Workshop (October 2013)

Appropriate Evaluation of UTI vs Asymptomatic Bacteriuria Webinar (December 2013)

Measurement Coaching and Learning Call (December 2013)

Evaluating Altered Mental Status in Elderly Long Term Care Residents Webinar(January 2014)

Supporting Improvement: Tools, Measurement, Engagement and Spread Regional Team Half-Day Workshops (February 2014)

Antibiotic Stewardship Across the Continuum of Care Conference Call (March 2014)

Expert coaching and learning from colleagues Faculty Conference Call (April 2014)

Final Workshop (June 2014)

Improving Infection Prevention and Antibiotic Stewardship through Quality Improvement Collaboratives: Tales from Two Successful Facilities Webinar (July 2014)

Healthcare Associated Infections

Improving Evaluation of Urinary Tract Infections in the Elderly:
Collaborative on Antibiotic Stewardship for Seniors in Long Term Care

Appropriate Evaluation of UTI vs Asymptomatic Bacteriuria
Webinar (December 2013)

Evaluating Altered Mental Status in Elderly Long Term Care Residents
Webinar(January 2014)

Supporting Improvement: Tools, Measurement, Engagement and Spread
Regional Team Half-Day Workshops (February 2014)

Antibiotic Stewardship Across the Continuum of Care
Conference Call (March 2014)

Expert coaching and learning from colleagues
Faculty Conference Call (April 2014)

Improving Infection Prevention and Antibiotic Stewardship through
Quality Improvement Collaboratives: Tales from Two Successful Facilities
Webinar (July 2014)