#ASPchat - A Monthly Conversation On Antimicrobial Stewardship

The #ASPchat on Twitter occurs via @ASP_Chat on the third Thursday of each month from 7:00 PM to 8:00 PM EST. This forum is meant to stimulate conversation on all things related to antimicrobial stewardship.

Who should participate…

Absolutely everyone is invited to participate. There are no limitations and the more diverse the group, the better.

We will be asking people in the fields relevant to the topic of that month to join in.

How to participate…

Log onto Twitter on one of the scheduled dates. Follow the hashtag #ASPchat and follow @ASP_chat.

From 7:00 to 8:00 PM EST on the dates below a tweet will be released every 10 minutes for the chat participants to comment on.

Get involved by using #ASPchat in your tweets. Share your insights, opinions, helpful resources and stories. Retweet and like tweets during the conversation. You can also tag people in your tweets to draw attention to the #ASPchat twitter chat.

You can share the graphic at the top of this page to help raise awareness as the #ASPchat dates come closer.

Mark your calendar, for this recurring event!!!

We got reviewed by JAC-AMR! Check it out…

Educational Resource Review: #ASPChat. JAC-Antimicrobial Resistance, Volume 3, Issue 3, September 2021.

Schedule & topics (tentative), 7:00-8:00 PM EST…

CALL FOR PARTNERS: If you are interested in partnering for any of the chats, DM @ASP_chat on Twitter or email IDstewardship@gmail.com

Upcoming Topics

We are currently on a break, but check back again soon!

Previous topics…

December 15th, 2016: Antimicrobial stewardship and the role of the pharmacist
January 19th, 2017: Antimicrobial stewardship and accrediting bodies
February 16th, 2017: Antimicrobial stewardship in the emergency department
March 16th, 2017: Antimicrobial stewardship and the rapid diagnostic testing
April 20th, 2017: Antimicrobial stewardship in and implementation science & design
May 18th, 2017: Antimicrobial stewardship and trainees (i.e., students, residents, fellows)
June 22nd, 2017: Antimicrobial stewardship and drug allergies
July 20th, 2017: Antimicrobial stewardship in the community setting
August 17th, 2017: Antimicrobial stewardship resources
September 28th, 2017 (re-scheduled): Antimicrobial stewardship and asymptomatic bacteriuria
October 19th, 2017: Antimicrobial stewardship and infection control
November 16th, 2017: Antimicrobial stewardship and how to bring attention to the cause
December 21st, 2017: Antimicrobial stewardship and the role of surgeons
January 18th, 2018: Antimicrobial stewardship and the microbiology laboratory
February 15th, 2018: Antimicrobial stewardship and critical care
March 15th, 2018: Canceled
April 19th, 2018: Antimicrobial stewardship and funding
May 17th, 2018: Antimicrobial stewardship and priority research areas
June 21st, 2018: Metrics for antimicrobial stewardship
July 19th, 2018: Antimicrobial stewardship and accrediting bodies
August 16th, 2018: Antimicrobial stewardship and rapid diagnostic testing
September 20th, 2018: The Status of Antimicrobial Stewardship Today
October 18th, 2018: New stuff in antimicrobial stewardship
November 15th, 2018: Antimicrobial stewardship and awareness for the cause
December 20th, 2018: Canceled
January 17th, 2019: Antimicrobial stewardship and social media
February 2019: Antimicrobial stewardship and mentorship
March 2019: Antimicrobial stewardship and duration of antimicrobial therapy
April 2019: Antimicrobial stewardship and local practice guidelines
May 2019: Antimicrobial stewardship and the microbiology laboratory
June 2019: Antimicrobial stewardship and influential published literature
July 2019: Antimicrobial stewardship and family medicine
August 2019: Antimicrobial stewardship and pearls for clinical practice (co-host: @PharmacyCCEd)
September 2019: Antimicrobial stewardship and preventing/ managing multi-drug resistant organisms (co-host: @SHEA_Epi)
October 2019: Canceled
November 2019: Antimicrobial stewardship and getting smart about antibiotics (c0-host: @CentreInfection)
December 2019: Antimicrobial stewardship and what we learned in 2019
January 2020: Antimicrobial stewardship and fluoroquinolones
February 2020: Antimicrobial stewardship and pediatrics
March 2020: Antimicrobial stewardship and COVID-19
April 2020: Canceled, supported the SIDP/SHEA chat
May 2020: Antimicrobial stewardship and lessons from COVID-19
June 2020: Antimicrobial stewardship and remdesivir (in collaboration with ACCP ID PRN)
July 2020: Antimicrobial stewardship and current COVID challenges
August 2020: Canceled
September 2020: Antimicrobial stewardship and symptom free pee
October 2020: When to use shorter courses of antibiotics
November 2020: Antimicrobial stewardship and the impact of COVID-19
December 2020: Antimicrobial stewardship and a potpourri of hot topic in 2020
January 2021: COVID-19 Vaccines
February 2021: Tele-stewardship (in collaboration with IDconnect, Intermountain, and University of Washington Tele-Antimicrobial Stewardship)
March 2021: Getting started with antimicrobial stewardship research (in collaboration with @SERGE_45_ABX)
April 2021: Canceled
May 2021: Antimicrobial stewardship & institutional guidelines (in collaboration with @SpectrumMD)
June 2021: Antimicrobial stewardship in large healthcare systems (in collaboration with @VAstewie)
July 2021: Canceled, will support ACCP ID PRN chat on Infectious Diseases Training via #IDPRNchat
August 2021: Antimicrobial stewardship and pharmacist certifications
September 2021: Antimicrobial stewardship and the drugs we love
October 2021: Antimicrobial stewardship and nudging (Co-host: @BiomerieauxUSA)
November 2021: Antibiotic awareness
December 2021: Hot topics in infectious diseases from 2021
January 2022: Antimicrobial stewardship and outpatient COVID therapies
February 2022: Antimicrobial stewardship and perseverance
March 2022: Canceled
April 2022: Antimicrobial stewardship and real talk about being a steward
May 2022: Antimicrobial Stewardship and complicated infectious diseases cases
June 2022: On educational strategies for antimicrobial stewardship
July 2022: Antimicrobial stewardship and the clinical practice guidelines (co-host Firstline)
August 2022: Antimicrobial stewardship and the mistakes we see over and over again
September 2022: Antimicrobial Stewardship and penicillin allergies
October 2022: Teaching antimicrobial stewardship in 2022
November 2022: Bringing awareness to antimicrobial resistance through ASP successes with the micro lab (Co-host: @bioMerieuxUSA)
August 2023: Hot Topics in Antimicrobail Stewardship (in collaboration with the Society for Healthcare Epidemiology of America)
October 2023: New Hits in Diagnostic Stewardship (Co-host: @bioMerieuxUSA)

Similar twitter chats to know about…

There are a few other groups looking to raise awareness and facilitate conversation on all things related to the urgent global health threat of antimicrobial resistance.

The group @ACCPINFDPRN has done Twitter chats using #IDPRN
The group @SIDPharm has done Twitter chats using #SIDP
The organization @CDCGOV does an annual Twitter chat using #AntimicrobialResistance
@IDJClub is pretty cool and worth checking out, they chat ~ monthly on Mondays @ 9pm
@IDchat1 once held chat sessions on infectious diseases topics weekly, but that account has gone dormant, maybe we will see it return one day

Other info…

Check out #ASPchat on Symplur here to see statistics on the use of this hashtag

Acknowledgements…

Dr. Brad Langford (@BRxAD) and Dr. Timothy Gauthier (@IDstewardship) are identified as the co-founders of this Twitter chat initiative, which aims to promote appropriate antibiotic use by stimulating conversation about antimicrobial stewardship.
The US CDC Get Smart Week (@CDCgov) is acknowledged for inspiring the creation of this Twitter chat, the first of which took place during the 2016 Get Smart Week.

Where to send questions or comments?

IDstewardship@gmail.com

Discussing the #ASPchat

Highlights from the December 15th, 2016 Twitter #ASPchat

TOPIC: Antimicrobial stewardship & the role of the pharmacist

Q1: What is the role of the staff or clinical hospital pharmacist in antimicrobial stewardship?
- @Julie_Justo: Amazing what they can do if they know the why behind ASP recs. Once we teach the concepts they run with it!
Q2: How can community-based pharmacists practice antimicrobial stewardship with limited free time?
- @BRxAD: Encourage adherence, but at the same time help dispel the myths about “finishing the full course” to prevent resistance
Q3: What would you identify as the PRIMARY role of an #antimicrobialstewardship pharmacist?
- @JMIDPharmD: Patient safety. The ultimate balance between risk and benefit. The primary role will depend though on hospital setting.
- @IDstewardship: #1 for me is leading change to the organizational culture and systems which promotes appropriate and safe antibiotic use.
Q4: How should #antimicrobialstewardship pharmacists engage non-pharmacist healthcare professionals to improve practice?
- @mmPharmD: View each intxn as teachable moment. With each abx approval, give a pearl of info. Bits of info over time = learning.
- @KisgenUF: Can’t come in with the mindset of antibiotic police. Must be collaborative and help everyone understand “why”.
Q5: Are there lines antimicrobial stewardship pharmacists should not cross?
- @KisgenUF: Quality care must come before cost. If we do the reverse we will end up hurting patients and our credibility.
Q6: How will the role of the antimicrobial stewardship pharmacist change in the coming years?
- @BRxAD: developing partnerships with behavioral scientists/sociologists to help better address antibiotic misuse.

Highlights from the January 19th, 2017 Twitter #ASPchat

TOPIC: Antimicrobial stewardship & regulatory bodies

Q1. From a philosophical perspective, what should the role of regulatory bodies be as it relates to antimicrobial stewardship?
- @IDstewardship: Regs should be multi-pronged –> patient safety AND protect antibiotics. Thankfully these things go hand-in-hand.
Q2. In what setting will it be / is it most challenging to address regulatory standards on antimicrobial stewardship? (7 votes: 0% acute care, 14% long-term care, 86% ambulatory care, 0% other)
- @KisgenUF: Ambulatory care is most challenging. Little to no EMR connection between MD and RPh, limited objective data (labs/Cx)
Q3. Which regulatory standard topic on antimicrobial stewardship are you most concerned about? (12 votes: 0% accountability/relationship, 50% patient education, 50% staff education, 0% other)
- @mmPharmD: How to be effective without overwhelming? How to target all patients without just handing out more papers?
- @HelenNewland: Right. Add to their 30-page discharge. RNs overburdened already. Pharms understaffed for face to face
Q4. Who is best positioned to provide required education to patients about antimicrobials? (7 votes: 43% nurses, 14% nurses, 14% providers, 29% other)
- @KisgenUF: We need to find ways to leverage our EMRs and EMARs to help with antibiotic education
Q5. What advice do you have or have you gotten to help address regulatory standards on antimicrobial stewardship?
- @HelenNewland: You’ve heard, “Never waste a shortage” Also “Never waste a regulation”
Q6. What resources would you recommend people access as they seek to adhere to antimicrobial stewardship regulatory requirements?
- @BRxAD: The @NatQualityForum antimicrobial stewardship playbook is a useful reference

Highlights from the February 16th, 2017 Twitter #ASPchat

TOPIC: Antimicrobial stewardship in the emergency department

Q1. What stewardship interventions are the highest yield in the ED?
- @KisgenUF: Have your nurses trained to draw cultures appropriately so we can minimize contaminated results. Or recruit skilled phlebotomist
Q2: What is the biggest barrier for doing antimicrobial stewardship in the ED?
- @NadiaEMPharmD: High patient turnover, uncertain diagnosis, and factors of prescribing accountability of antimicrobials in the ED
- @BRxAD: Diagnostic uncertainty coupled with a sense of urgency to tx often lead to over-tx and broader spectrum than needed
Q3: What is the role of ED PHARMACISTS to support stewardship efforts?
- @Real_IDPharmD: Some EDs starting code sepsis, can screen allergies, screen risk factors for nosocomial coverage, select appropriate ABX
- @NadiaEMPharmD: Promotion through education. Consider patient risk factors AND suspected bug(s) when selecting antimicrobials.
Q4: How can inappropriate antibiotic use in the ED be reduced?
- @mmPharmD: Adopt rapid diagnostics. Does your have an ED PharmD and RDT? Can I come work for you??
- @NadiaEMPharmD: Surveillance of prescribing trends, challenging cases, and rates of antimicrobial resistance can make big wins.
Q5: How should patient education in the ED be undertaken?
- @IDstewardship: Engaging trainees I always see as a win, investing in the future. Important to be a mentor.
- @KisgenUF: If you have a culture review service, take advantage of call backs to educate patients about MRSA, STDs, and Cdiff
Q6: What antibiotic education message is MOST important for ED patients?
- @Real_IDPharmD: URIs don’t need ABX https://www.cdc.gov/getsmart/community/for-hcp/outpatient-hcp/adult-treatment-rec.pdf …

Highlights from the March 16th, 2017 Twitter #ASPchat

TOPIC: Antimicrobial stewardship and rapid diagnostic testing

Q1. What is your opinion on rapid diagnostic tests for abx stewardship?
- @real_IDpharmD: Needs thoughtful planning and assessment prior to implementation but can help improve pt outcomes
- @ErinMcCreary: @manfordou takes education & respect for micro lab as well. not just having machine but knowing when techs there to work it!

Q2. What metrics should be used to justify #RapidDiagnosticTesting personnel + equipment resource commitments?
- @DrSkiPharmD: we got provider engagement. Showed them the evidence and they became the champions
- @IDstewardship: Building coalitions & relationships is something that has so much value, repeatedly comes through as clutch

Q3. What is the best way to approach rapid diagnostics test implementation?
- @DHpharmD: Clinical pathways very helpful for interpretation but can never be 100% perfect do need room for shimmying a bit

Q4. What are institution-specific considerations for rapid diagnostic testing?
- @Manfourdou: consider investing some multidisciplinary time into designing report wording and format for RDTs prior to launch pays
- @IDpharmacist: Costs and volume of testing; availability (or lack thereof) of ASP/ID to f/u on test results is a challenge too

Q5. With rapid diagnostic tests, where is the most “bang for your buck” delivered?
- @IDstewardship: Seems GPC-clusters in blood biggest opportunity, reduce LOS, get people off of vanc
- @timbrooktt: looking at just cost? MALDI may be expensive to buy, but to run is like $0.10/sample and SAVES over tradition id
- @IDpharmacist: Perhaps rapid de-escalation of therapy based on RDT results- ie blood cultures for CNS/contaminants, narrower spectrum for MSSA etc
Q6. What unanswered questions do you have at the X-roads of rapid diagnostic testing & antimicrobial stewardship?
- @mmPharmD: Outcomes data! Please please please publish your experience with RDTs!

Highlights from the April 20th, 2017 Twitter #ASPchat

TOPIC: Antimicrobial stewardship implementation science and design

Q1. What is an example when implementation science & design is relevant to antimicrobial stewardship?
- @SHSUHNASP: In designing our guidelines and educational tools I have learned to understand workflow & importance to involve end-users
Q2. When designing or preparing for implementing a new service/ system, where should we start?
- @Jackie_Quirk: In imp sci, once we know the goal, we can go fwd & collect info on challenges (barriers) & supports (facilitators) for change
Q3. Are there major pitfalls to beware when designing or implementing a new #abxstewardship tool or service?
- @BWDionne: Make sure stakeholders are aware (and involved) early. Better to have them asking when it’s coming than surprised by it’s release.
- @KisgenUF: Setting expectations too high. Need to make realistic goals so you don’t overpromise and underdeliver
- @SHSUHNASP: 1) Ignoring the enduser’s needs, wants & workflow 2) let the tool or service go “stale” without periodic evaluation &/or update
- @BRxAD: Often we think of education as the solution, but barriers are not always knowledge, lots of other behavioral factors to consider
Q4. What technique is most helpful for identifying the quality of a new tool/service during the implementation phase?
- @dest112: FaceTime is so critical. Majority ASP recs can be accomplished during walk rounds with ID consult service.
- @KisgenUF: If it’s a new IT related tool, have end users try it out in “test mode” first to see if it has value and identify barriers.
- @SHSUHNASP: we had healthcare human factors engineers to conduct qualitative study to find out what the endusers liked/disliked about the tool
Q5. What design principles can be used to make complicated systems more user friendly?
- @BRxAD: Put information where users are more likely to see/need it. We added some prescribing information to a pen
Q6. What resources or examples do you refer to or recommend for designing/implementing changes in healthcare?
- @Jackie_Quirk: If interested in more about implementation sci (not ASP specific), I like these resources from @ImpScience http://unc.live/2nfjOCN

Highlights from the May 18th, 2017 Twitter #ASPchat

TOPIC: Antimicrobial stewardship & trainees

Q1. How are didactic or experiential curricula in your profession evolving to include #AntimicrobialStewardship concepts + principles?
- @ErinMcCreary: incorporate #ASP into non-ID course. Ex:taught ‘ABX in ICU’ lecture to P3 CC elective class, much of lecture devoted to stewardship
- @DHpharmd: Teach a stewardship elective at my pharmacy school, focus on bigger picture including regulatory, QM, infxn ctrl, micro, global AS
- @ByGhanem: Need to incorporate antimicrobial stewardship principles early in pharmacy curricula
Q2. Which trainee group do you want to engage most for #AntimicrobialStewardship education and why?
- Poll response: 39 votes; 44% students/interns; 44% residents; 3% fellows; 9% other
- @DHpharmd: See every trainee as an opportunity to influence a future colleague/clinician. Physician and nurse trainees too!
- @BRxAD: Better to engage all trainees, rather than just those with a focus/specialty
- @TheEDpharmacist: I like training anyone who’s excited to learn! Noob or experienced, it great to feed off each other’s energy
Q3. What activities have you found most effective for helping trainees learn about #AntimicrobialStewardship?
- @IDstewardship: Pharmacy students & residents often get their minds blown by going to the #microbiology lab …actually seeing MRSA!
- @DHpharmd: Combining trainees of different disciplines fosters interprofessional learning, communication and respect
- @Khalideljaaly: Reviewing drug-bug mismatch & dose optimization
- @XanderBOS: Speaking as a trainee, presenting cases, especially ones where a you’re recommending a different tx than current staff plan!
Q4. Are there areas of low-hanging fruit for interdisciplinary #AntimicrobialStewardship education?
- @HelenNewland: I like idea of RNs to put antibiotics on daily checklist just like DVT prophylaxis. Easy “timeout” to ask MD when comes by
- @ErinMcCreary: if pencillin-allergic ask “have you ever had augmentin or keflex?” shocking how many answer yes
Q5. How can we inspire the future generation to take interest in learning about #AntimicrobialStewardship?
- @Dest12: Patient cases of untoward outcomes due to resistance/overuse of antimicrobials. Ask “what would you do if this was your family”?
Q6. How big of an issue is the mismatch btwn the current supply & likely future demand of ID/stewardship MDs & PharmDs?
- Poll response: 41 votes; 5% not really a problem; 15% kind of an issue; 54% a substantial issue; 26% red alert!
- @BRxAD: Important to consider resource limited/rural settings where #antimicrobialstewardship is particularly lacking

Updating this became too much of a task to continue. Please visit the @ASP_chat Twitter account and scroll through feed to see what comments were made. The account has limited retweets to enable easy viewing of previous chats. Here are STATS from the chats…

June 2017 Chat: Antimicrobial Stewardship & Drug Allergies