Becker's Hospital Review

59 FINANCE CMO / CARE DELIVERY FDA proposes antibiotic subscription plan for hospitals By Megan Knowles F DA Commissioner Scott Gottlieb, MD, on Sept. 14 outlined the agency's plan to fight antimicrobial re- sistance, which includes a proposal for a subscrip- tion-based model for hospitals access to antibiotics. The FDA's plan centers on four main goals: facilitate prod- uct development for safe and effective treatments, pro- mote antibiotic stewardship, support antimicrobial-resis- tance surveillance and advance regulatory science. As part of this plan, Dr. Gottlieb proposed reimbursement reforms that could include milestone payments or sub- scription fees for drugmakers who create FDA-approved products targeted at multidrug-resistant organisms and are associated with proven clinical outcomes. "A subscription-based model could see hospitals paying a flat rate for access to a certain number of doses of an import- ant new antimicrobial," Dr. Gottlieb said. "These subscription fees could be priced at a level to create a sufficient return on the investment to develop drugs with a certain profile." The agency is considering potential approaches to these pro- posals with CMS and other agencies. The FDA also introduced a new web page to track its work on antimicrobial resistance. "We can't count on outracing drug resistance. But we can use stewardship and science to slow its pace and reduce its impact on human and animal health," Dr. Gottlieb said. n How the nationwide IV bag shortage helped Texas Health boost patient, nurse satisfaction By Alia Paavola H ospitals across the nation have been grappling with a shortage of IV bags since Hurricane Maria slammed Puerto Rico and caused manufacturing disruptions last year. While supply short- ages generally cause problems for healthcare organizations, one hospital — Texas Health Presbyterian Hospital Dallas — said this shortage has morphed into a positive experience for both patients and staff. IV bags are a critical supply for hospitals because they help clinicians administer medications quickly. Prior to the shortage, the normal pro- cess involved hooking an IV bag mixture to an IV pump that would deliver the medication automatically without the need for the nurse to remain at the bedside. However, the IV bag shortage has changed this process, forcing clini- cians to use different strategies, such as manually administering the drugs through syringes. While this workflow change was worrisome at first, Texas Health nurses said there's been a surprising result: ey've been able to spend more personal, quality time with patients. "Initially, I expected the change in process was going to take more time, as we were so accustomed to using a pump and IV bag," Tessa Kennedy, RN, a clinical nurse at the hospital, said in a press release. "What I actually found was it gave me more time with my patients, getting to know them, to provide education and simply have a conver- sation while doing the IV push." e automated IV pumps were introduced in hospitals around the country years ago as a time-saving, error-reducing solution for nurses — especially as the number of daily, non-nursing tasks on their plate piled up. ese time-consuming tasks have detracted from what nurs- es want most: time with patients. "Nurses can spend a significant amount of time on non-nursing tasks — hunting and gathering equipment, communicating and coordinat- ing between departments and on documentation, leaving less time for actual patient care and presence with patients and families," explained Texas Health Presbyterian Hospital CNO Cole Edmonson, RN. "So anything that gives nurses back time to spend with patients, being present and in the moment is truly welcomed in this age of technology and digital equipment." Spending more time at the bedside or "going back to the old way of giving medications," as one nurse explained, has also increased patient satisfaction. During a meeting held by clinical leaders, patients said they enjoyed the increased time with nurses, adding that the personal time improved their experience at the hospital. Nurses said the IV- push method also led to an improved patient experience because there were fewer beeping machines, which allowed patients to more com- fortably rest. Beyond improving staff and patient satisfaction, the workflow change also strengthened the relationship between the nursing department and pharmacy, produced less waste from tubing and bags and generated some cost savings, according to Randell Ball, Texas Health Presbyterian vice president and system pharmacy officer. e two departments worked closely to maintain patient safety and re- duce the potential for incorrect dosing. "When discussing the need to move to syringe-based dosing, the pharmacy worked with nursing leadership to identify those medications that could be safely provided in syringes of 30 milliliters or less and could be safely given by IV push over five minutes or less," Mr. Ball explained. Overall, the hospital was able to turn a nationwide IV shortage into something patients and staff were happy about. "Out of a terrible tragedy [Hurricane Maria] and in the most respectful way to everyone impacted, we found some unexpected collateral benefit to our patients' and nurses' experiences," Mr. Edmonson said. n

• Cover