The signing of the National Strategy for Combating Antibiotic Resistant Bacteria executive order by President Obama has brought a heightened sense of awareness to the need for antimicrobial stewardship programs (ASP).
For those teams that are just beginning their program, a great place to start is by reviewing the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship and the Centers for Disease Control and Prevention (CDC) Core Elements of Hospital Antibiotic Stewardship Programs. These guidelines provide the basic framework for an ASP including those services and strategies that offer the most value.
For more established ASPs, it may be beneficial to take a fresh look at the potential directions you can take your programs. Those professionals actively participating in an ASP might want to compare their current antimicrobial stewardship initiatives or practices to those published in the literature. In addition, the use of a gap analysis tool can be a highly efficient approach to optimize practices. The Wolters Kluwer AMS Gap Analysis Survey, for example, generates ratings that can help identify program gaps compared to best practices. This tool was designed using existing best practice information from organizations such as the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the American Society of Health System Pharmacists (ASHP) and the CDC.
Common gaps identified include the need for new policy development, additional staff education and more tools or resources that support program advancement. Once program gaps are identified, the next task for the team is to create a project plan that includes a timeline for implementation of the identified improvements. The project plan should be separated into phases that are within the team’s scope and abilities to ensure successful implementation and integration into the care management workflow. For example, an identified need for policy development that supports pharmacy managed vancomycin dosing might include a first step of implementing a standard dosing guideline. As the service matures and value is recognized, the next phase may be to seek approval for the pharmacists to dose all the vancomycin prescribed across the facility. The stewardship committee should determine a time frame for deploying these new services or improvements to keep the program on track and advancing.Clearly, as the executive order details, the requirement for healthcare facilities to have antimicrobial stewardship programs in place is coming in the near future. Examining your practice environment now and beginning to determine the path for implementing a new program or optimizing your existing one is an activity everyone should be considering. Practice guidelines are available to help guide your way.