Improving Healthcare Outcomes through Antibiotic Stewardship and Virtual Rapid Response Program

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This project focuses on enhancing healthcare outcomes by implementing an Antibiotic Stewardship program and utilizing Virtual Rapid Response Teleconsultation in skilled nursing facilities. The initiative includes developing best practice protocols, educating staff on infection prevention, antibiotic stewardship, and sepsis treatment, as well as training Virtual Rapid Responders. Follow-up procedures involve prompt evaluations of patient responses and close coordination with healthcare providers. The goal is to reduce hospital readmissions and improve patient care delivery.


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  1. Maury Regional Healthcare CMP Grant Project

  2. Antibiotic Stewardship Infection Prevention Early Care & Treatment for Resident/Patient Treat In Place Virtual Rapid Response Teleconsultation (VRRT) Improved outcomes Reduce Hospital Readmissions

  3. Hospital Skilled Nursing Facilities Regional Antibiogram developed by the Infectious Disease PharmD provided to SNF PCP s. Best practice standard operating procedures (SOP) developed using Antibiograms, and current best practice standards of hospital rapid response team protocols. Development and training of Virtual Rapid Responders Review current practices revising if needed Education on best practice guidelines for Infection Prevention, Antibiotic Stewardship and Sepsis Training on VRRT process and telehealth equipment

  4. Pre/Post Assessment Quiz Score Pre/Post Assessment Quiz Score SNF Education IP/AS & Sepsis 788 800 100 90 96 96 700 Number Of Staff 93 93 91 91 80 11 SNF Combined # of Employees 648 Pre Assessment Quiz % 600 70 500 447 60 Quiz Score Quiz Score Number Attended Education 400 50 341 Post Assessment Quiz% 40 80.2 300 74 327 321 64 30 200 20 Percentage 96 82 72 100 10 0 0 Licensed CNA Total Licensed CNA Total Discipline Discipline Discipline Aug 19- Feb. 20

  5. VRRT Education 120 Jan. 2020 through Sep. 2021 100 80 60 40 20 0 Early VRRT VRRT Simulation Attendees Recognition & Treatment of Sepsis in SNF Equipment Training MOCK Sim. w/ Responder Responders Currently Training Active VRRT Responders Intro to VRRT Responders Trained Staff Education 80 73 96 79 19 21 2 5

  6. SNF nurse and VRRT responder follow-up within 1-4 hours to evaluate patients response to interventions PAC Education Coordinator reviews all diagnostics and follow up with SNF nurse within 24 hours and as needed Consult to Infectious Disease PharmD on all encounters involving infectious processes within 24 hours and as needed SNF provider notified of encounter per center s protocol

  7. 50 Other Reasons: Other Reasons: 45 Elevated Ammonia Weakness Cellulitis/edema Confusion AMS/Lside Missed Dr. appt Vomit dark blood CP/Hypotension Rectal bleed AMS/Overmedicated Elevated Ammonia Weakness Cellulitis/edema Confusion AMS/ Missed Dr. Vomit dark blood CP/Hypotension Rectal bleed AMS/Overmedicated 40 35 Lside weakness appt for leg wound weakness 30 for leg wound 25 20 15 10 5 0 Total 44 Total 44 PNA PNA 9 9 UTI 9.5 UTI 9.5 SSTI 7.5 SSTI 7.5 COPD Ex 1 1 COPD Ex CHF Ex CHF Ex 3 3 Covid Covid 4 4 Other 10 Other 10 VRRT Encounters VRRT Encounters Sep 20 Sep 21

  8. 30 30 27 27 25 25 20 20 44 VRRT Encounters 44 VRRT Encounters 15 15 10 10 6 6 4 4 5 5 2 2 2 2 2 2 1 1 0 0 Keep & Treat Keep & Treat Treat & Transfer Treat & Transfer Emergent Transfer Emergent Transfer VRRT VRRT ER visit for diagnositics ER visit for diagnositics Failed Failed No No Diagnositcs Only Diagnositcs Only Treatment txfr to ER Treatment txfr to ER Intervention Intervention Sep 20 Sep 21

  9. 30 28 25 20 16 NON SEPSIS 15 SEPSIS 12 Infectious Process 10 5 0 NON SEPSIS SEPSIS Infectious Process Sep 20 Sep 21

  10. Mar 19-May 21

  11. 80 74 70 * Outside of MRH ER N/A Not yet available 60 50 44 40 33 31 27 30 26 18 18 20 7 10 6 5 5 4 3 1 1 0 Avail. NHC Maury Avail. Lewis Co Avail. NHC Columbia Avail. *NHC Pulaski Avail. *NHC Scott Avail. Mt. Pleasant N/A LifeCare N/A *NHC Lawrenceburg N/A NHC Oakwood N/A NHC Lewisburg N/A Magnolia VRRT Encounters Missed Opportunties

  12. Next site training now (October 2021) Plans to train 3 sites in November & December Continue offering MOCK VRRT training to all SNF s All 11 SNF s actively using the VRRT program by March 1st, 2022

  13. Theresa Harris, RN, MSN, CCRN-K, ACCNS-AG Post Acute Care Education Coordinator Maury Regional Healthcare tharris@mauryregional.com

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