The #ASPchat on Twitter occurs 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!!!
Schedule & topics (tentative), 7:00-8:00 PM EST…
- 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 14th, 2017: Antimicrobial stewardship and the role of publishers
- 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
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 organization @CDCGOV does an annual Twitter chat using #AntimicrobialResistance. The last one was held November 18th, 2016
- @IDchat1 once held chat sessions on infectious diseases topics weekly, but that account has gone dormant, maybe we will see it return one day
- Check out #ASPchat on Symplur here to see statistics on the use of this hashtag
- 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 – all comments & questions are welcomed!
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