Posted on December 10, 2014
As the number of organisms resistant to common antimicrobials continues to rise, hospitals have responded by creating antimicrobial stewardship programs (ASPs). These programs promote the optimal use of antimicrobials by employing a variety of interventions to improve patient outcomes and reduce microbial resistance in the hospital and community. High performing antimicrobial stewardship programs have eight key components identified by the Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America: 1,2
Leadership commitment: Because ASPs involve many departments and key personnel within a hospital, effective programs have support at the top of the organization that ensure they have sufficient budget, authority and resources.
Accountability: The active leadership of a physician champion is crucial to the success of an antimicrobial stewardship program. Often, an infectious disease specialist takes on this role and advocates the use of good antimicrobial practices throughout the organization. This role is especially important for securing the commitment of a hospital’s physicians who may be resistant to changing their established practices and preferences without direct communication from a convincing peer.
Drug expertise: A senior pharmacist must also be integrally involved in the program to ensure that prescribing practices conform to recommended standards, that physicians are alerted to bug-drug mismatches, and that documentation supports appropriate drug, dose and duration for key organisms and conditions.
Multidisciplinary approach and team: A high performing antimicrobial stewardship program involves many other departments besides pharmacy and infection prevention. Microbiology, health information technology, laboratories, nursing and other departments also play important roles to ensure the appropriate antibiotics are used for infections in the recommended dosage and length of time within the hospital.
Prioritized introduction of policies: Antimicrobial stewardship programs can include a large number of policies but each hospital should prioritize these policies and implement them one at a time. The phased introduction of antimicrobial stewardship elements prevents overload, avoids confusion and ensures adoption of initial strategies. Many hospitals first develop recommendations for drug, dose and duration for specific infections and requiring clear documentation of diagnosed infection and prescribed treatment on patient records so that discrepancies are easily identified. Others implement antibiotic “time-outs,” require prior authorization for certain drugs, introduce infection-specific interventions or implement pharmacy-driven interventions such as automatic stop orders for prophylaxis.3
Measure: Implementing metrics that assess adherence to policies, track outcomes, monitor antibiotic use and evaluate costs encourages more rapid adoption of the elements of a successful ASP.
Report: Reports provide ongoing feedback about which policies have been embraced by the organization and where improvements are needed. Reporting enables the hospital to track performance over time, commend adoption of best practices, and direct interventions for greatest impact. High performing ASPs typically share data with prescribers that include the hospital’s antibiogram and provide personalized reports on prescribing patterns and opportunities for improvement.
Ongoing education: As the hospital rolls out additional policies and recognizes areas that need greater attention, staff need continuing education to stay aware of emerging risks, learn about new recommendations and gain reinforcement on existing practices and their rationale.
Are there other components to your ASP? Let us know in the comments below.
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.
3. American Society of Health-System Pharmacists. A Hospital Pharmacist’s Guide to Antimicrobial Stewardship Programs.
Written for clinicians