Antimicrobial stewardship programs range from one or two straightforward initiatives affecting one or two units to complex, programs that span departments. Wherever your hospital is in the development of its antimicrobial stewardship (AMS) program, you want to know what to we do next? The best way to answer that question is to conduct a gap analysis.
You can use our checklist to track and report antibiotic use based on recommendations from the Centers for Disease Control and Prevention (CDC). The CDC recommends a focused, well-paced approach to introducing new antimicrobial stewardship policies to ensure that staff have time for training and that hospitals can assess the impact of one initiative before adding others.
Recommendations from the CDC and the Infectious Disease Society of America (IDSA) encourage all AMS programs to include the following eight elements:1,2
Leadership support: Real support includes both a formal, written statement endorsing efforts to improve antimicrobial stewardship as well as clearly budgeted funds to support AMS activities, such as salaries, training and IT support. Words alone will not get a program running; funding without overt leadership support risks more pushback from physicians and staff.
Accountability: A physician leader, preferably one with infectious disease training, provides an invaluable communication link and source of credibility with medical staff, particularly senior physicians who may be more resistant. The physician leader also accepts accountability for the program and communicates with hospital administration. Do you have a physician who is clearly in charge of your AMS program? If so, is this physician’s time spent on antimicrobial stewardship adequately? That’s an important next step to ensure the physician leader can devote sufficient time and energy to making sure the program succeeds.
Drug expertise: A pharmacist provides essential drug expertise and may serve as co-leader of the antimicrobial stewardship program. Some programs split this role between two or more pharmacists, but it’s a good idea to have one who has primary responsibility. If the designated pharmacist has infectious disease training, that is even better.
Broad support: A high-performing AMS program includes team members from and coordination with infection prevention, epidemiology, microbiology, nursing, quality improvement and IT as well as other departments. If your program is missing any of these key players, work on involving them in your efforts.
Actions and interventions: This area has the most flexibility. Choose one initiative to start, then add from the lists here and on the CDC checklist:
Require prescribers to document indication, agent, dose and duration for all antibiotic prescriptions.
Implement treatment recommendations based on national guidelines, local susceptibility and your facility’s antibiogram for common conditions.
Establish a formal procedure for antibiotic timeouts within 48 hours.
Specify antibiotics that require pre-authorization.
Implement prospective review and feedback of antimicrobials for appropriate agent, dose and duration based on organism and patient specifics.
Make the switch to oral antibiotic therapy from intravenous automatic when appropriate.
Review antibiotic prescriptions for unnecessary duplication.
Develop infection-specific interventions to optimize the use of antibiotics for common conditions.
Monitor: Continuous improvement and ongoing funding depend on documenting and communicating results to both hospital administrators and to prescribers. Tracking and reporting on compliance with documentation policies is a critical first step. Hospitals then often add reporting on adherence to facility-specific treatment recommendations and pharmacy interventions by unit and prescriber, with feedback to all clinicians. The CDC recommends monitoring and sharing C. difficile infection rates as well as the facility’s antibiogram. Other common metrics include days of therapy, defined daily dose and antibiotic cost.
Education: Clinicians and staff need to understand why antimicrobial stewardship matters and how the hospital plans to improve its stewardship and what they need to do to help. Ongoing education is a critical component of all high-performing AMS programs.
If you want to see how your program compares to others as well as what next steps you should consider, take our AMS Gap Analysis survey. It’s free, brief, and informative.
What’s the next step for your hospital’s antimicrobial stewardship program?
1. CDC. CDC/IHI Antibiotic Stewardship Drivers and Change Package. Get Smart for Healthcare.
2. Dellit et al: Clinical Infectious Diseases 2007; 44:159–77.