Posted on March 24, 2015
Once you’ve made a commitment to implementing an antimicrobial stewardship program (ASP), you’ll want to track how well it’s performing. You’ll also want to share results with others in your hospital to increase support for the program and drive changes in behavior through regular feedback. While the relevant measures for your hospital will depend on which strategies you have implemented, you may consider capturing and reporting on:
Antimicrobial use: Reducing unnecessary use of antimicrobials is central to a successful ASP. Typically, facilities measure usage as the number of days of therapy (DOT) and the number of defined daily doses (DDD), based on the average daily dose of an antimicrobial for a standard patient as set by the World Health Organization (WHO). Both are typically expressed in terms of 1,000 hospitalized patient-days.1
Antimicrobial costs: As inappropriate use of antimicrobials decline, pharmacy costs typically go down, too. The costs savings come from lower overall use of antimicrobials and reduced use of broad spectrum and more expensive antimicrobials when narrower therapies would be effective. Facilities may track either the total pharmacy cost for antimicrobials per month or the pharmacy cost for antimicrobials per discharge per month, if the census varies significantly.2
Appropriate initial selection: To know whether the right antimicrobial was prescribed, you need to know what pathogen was being treated. You’ll want to track the percentage of cases in which the prescribing physician selected an antimicrobial on known culture results. If the patient’s condition warranted starting empiric therapy, how often did the prescriber review culture results within 24-48 hours to verify the appropriateness of the prescribed medication?
Antimicrobial resistance patterns: What is the prevalence of resistant healthcare-associated pathogens by unit or for the facility overall? How has that shifted over time? Among the pathogens most commonly monitored are methicillin-resistant Stapholococcos aureus (MRSA), vancomycin-resistant Enterrocci (VRE), Escherichia coli and Klebsiella pneumonia and K. oxytoca.
Adverse drug events: Broader spectrum antimicrobials tend to have significant side effects, among them an increased risk of infection with Clostridium difficile. Antimicrobial stewardship programs often produce significant reductions in C. diff. infections and may also lead to declines in other adverse events.
Adoption of treatment recommendations: Some ASPs provide guidelines for specific changes in common practices such as not treating asymptomatic bacteriuria. Others may call for a regular review of intravenous antimicrobial use with a goal of switching patients as quickly as advisable to oral medications or may stop antimicrobial administration after 24-48 hours without a verified culture. If your facility implements policies such as these, you’ll want to track the percentage of the time prescribers, nurses and other staff follow the recommendations.
Acceptance of ASP recommendations: Antimicrobial stewardship programs work by training and intervening to change behavior. If the education and intervention are not leading to different results, you need to know that quickly and take steps to make the program more effective. Many hospitals measure the percentage of recommendations accepted by physicians, both overall and by prescriber. Some also track antimicrobial prescriptions by provider. These metrics are then reported to administration and provided to every provider so that they can see how their rates compare to their peers.
Griffith M, Postelnick M, Scheetz M. Antimicrobial Stewardship Programs. Expert Rev Anti Infect Ther. 2012;10(1):63-73.
Centers for Disease Control and Prevention. Antibiotic Stewardship Measurement Framework. July 4, 2012.