Posted on December 16, 2014
Establishing goals is an integral part of establishing a high performing antimicrobial stewardship program (ASP). Without clear metrics, you will not know where you have achieved success and where additional training may be required.
What goals should you set? Start with these four recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the Australian Commission on Safety and Quality in Health Care: 1,2
A high performing ASP will reduce expenditures on antibiotics as the number of unnecessary and inappropriate prescriptions drop. Since studies show that up to 50% of antibiotic prescriptions in U.S. hospitals may be inappropriate, the savings can be substantial. In addition, the use of the narrowest-spectrum antibiotic considered effective against a specific infection can reduce the usage of and need for more costly broad-spectrum antibiotics.
A fully developed ASP will include a number of elements, each with its own policy. As a first step, many hospitals introduce steps to optimize selection, dose and duration of treatment for targeted infections. Measures may include the rate of appropriate prescription by provider and for the facility and the number of drug-bug mismatches picked up by the pharmacy or surveillance system. Hospitals often implement policies that encourage switching from IV to oral drug administration, mandate “time outs” to reassess the appropriateness of antibiotic therapy, and institute stop orders for prophylaxis. Metrics can capture the rate of adherence to these policies for each provider, unit and the facility as a whole.
As the number of unnecessary prescriptions declines, the rate of preferred drug-bug matches climbs. Because adherence to established dosage and duration guidelines by providers will then increase, antibiotic use in the hospital should drop. Capturing overall antibiotic usage and use of specific antibiotics will reveal whether physicians have adopted good antimicrobial stewardship practices. A sudden spike may also indicate that your facility has encountered new resistant strains. Tracking a patient’s days of therapy as well as the defined daily dosage will provide insight into acceptance of treatment guidelines.
Improving patient outcomes is one of the most important goals of an ASP. Hospitals will want to track morbidity and mortality associated with multidrug resistant organisms (MDROs) as well as length of stay data. More advanced metrics may include the rate of secondary or superinfections such as Clostridium difficile or another multidrug resistant organism. ASPs may also monitor the frequency of adverse drug events associated with specific antibiotics.
Do you have other measures of success for your ASP? Let us know in the comments below.
1. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
2. Looke D, Duguid M. Chap. 5: Measuring the performance of antimicrobial stewardship programs, in Duguid M, Cruickshank M (eds). Antimicrobial stewardship in Australian hospitals. 2101. Sydney: Australian Commission on Safety and Quality in Health Care.