Education provides the foundation for every effective antimicrobial stewardship program. High-functioning antimicrobial stewardship programs change prescribing behaviors as a result of educational efforts that build understanding of the need for antimicrobial stewardship (AMS), and the core elements of effective stewardship that are combined with direct interventions and feedback. High turnover at hospitals combined with rapidly mutating organisms and the rollout of new policies necessitate ongoing training.
AMS programs need to keep healthcare providers current on antibiotic resistance patterns in pathogens seen commonly in their hospital as well as aware of local and national trends that may soon affect them. For hospitals with a robust infection surveillance program, a facility and unit-specific antibiogram should be shared and discussed, so that providers can understand how effective various antibiotics are against particular infections. Recent research conducted at the Oregon State University/Oregon Health & Science University College of Pharmacy indicates that in skilled nursing facilities up to 85% of antibiotics are prescribed empirically, and 65% of them are inappropriate based on laboratory results. Using an antibiogram can increase appropriate prescribing rates by 40%.1
Other forms of antimicrobial stewardship education can improve bug-drug matches and overall antimicrobial usage. Hospitals may develop preferred therapies for specific infections and establish recommendations for dose optimization, which will need to be communicated through training programs and interventions. Sharing reports that track the use of antibiotics within the facility, the appropriate prescriptions rates, and the bug-drug match rate by prescriber can also positively affect prescribing patterns, according to the Centers for Disease Control and Prevention (CDC).2
In group settings, a review of de-identified cases can demonstrate how better antibiotic choices can improve outcomes and drive home the importance of careful selection. Posters, flyers and electronic reminders may keep AMS top-of-mind for prescribers who might otherwise slip back into old prescribing habits.
AMS education needs to be accompanied by direct feedback to be effective, so prescribers know specifically what they're doing right and where they can improve. If you've implemented prospective auditing of prescriptions, get back to the prescriber quickly if a change needs to be made and explain why. On a regular basis, provide feedback to all prescribers on how they are doing relative to other prescribers and how the facility has performed relative to its antimicrobial stewardship goals.
1 Furuno JP, Comer AC, Johnson JK, Rosenberg JH, Moore SL, MacKenzie TD, Hall KK, Hirshon JM. Using antibiograms to improve antibiotic prescribing in skilled nursing facilities. Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S56-61.
2 Core Elements of Hospital Antibiotic Stewardship Programs. Get Smart for Healthcare. CDC. March 4, 2014.