While many hospital executives, physicians and clinicians recognize the danger of multidrug resistant organisms and the importance of appropriate antibiotic use, implementation of antimicrobial stewardship continues to lag in American hospitals. Often the disconnect between awareness and action arises from uncertainty on how to proceed or from inadequate support throughout the organization. If you’ve decided to implement an antimicrobial stewardship program in your hospital, address these four key issues first to get off to the best start:1,2
Obtain leadership commitment—High functioning antimicrobial stewardship programs require the engagement of personnel across multiple departments and commitment to ongoing education. To ensure everyone works together and the antimicrobial stewardship (AMS) program has sufficient budget, technology resources, time, and authority, one or more senior members of hospital leadership must provide active support. Management will also need to participate in establishing goals, prioritizing policy introduction and monitoring program results.
Find a champion—Someone needs to lead the charge. In many hospitals, an infectious disease specialist takes on the role as chief advocate of good antimicrobial practices throughout the organization. While the support of hospital leadership is essential, the choice of a champion can make or break a program. A senior physician can often persuade other established clinicians to adopt appropriate stewardship practices in their departments and will have the respect needed to effectively intervene to change established prescribing practices among their peers.
Enlist a pharmacist—At root, AMS is about managing drug use. A pharmacist, preferably with infectious disease training, brings essential drug expertise to the program and can ensure hospital policies encourage prescribing practices that conform to recommended standards. They are also well positioned to alert physicians to bug/drug mismatches and ensure medical records support the drug, dose and duration prescribed for the specified infectious organism and patient conditions.
Create a multidisciplinary team—An effective antimicrobial stewardship program pulls together team members from multiple hospital departments. Infection prevention, pharmacy and hospital epidemiology typically take the lead, but participation by microbiology, health information technology, laboratories, nursing, quality assurance and patient safety contribute significantly to the rapid adoption of good stewardship practices and the program’s long-term success.
1 CDC. Core Elements of Hospital Antibiotic Stewardship Program. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
2 Dellit et al: Clinical Infectious Diseases 2007; 44:159–77.