Posted on March 25, 2015
Antimicrobial stewardship programs (ASPs) offer a number of opportunities to reduce hospital pharmacy costs, while also improving patient care and safety. Hospitals frequently introduce antimicrobial stewardship in phases and each step includes interventions that can lower costs. Six common steps include:
Only prescribing antimicrobials when needed. Up to 50% of antibiotics prescribed in hospitals are unnecessary or inappropriate, so ensuring that use of an antimicrobial is indicated—and documented—significantly reduces pharmacy costs.1 As part of this step, hospitals may institute automatic stops to antimicrobial use if the suspected infection is not clinically verified within 48 to 72 hours.
Restricting broad spectrum, expensive antimicrobial use. Many ASPs require preauthorization or criteria-monitored use of specific broad-spectrum medications to reduce selective pressure for specific resistant organisms and rein in costs. Others review prescriptions to identify opportunities to streamline therapy to a narrower spectrum antimicrobial. ASPs have achieved savings of more than 30% by implementing these steps.2
Switching patients from intravenous to oral antimicrobials as soon as they stabilize. Many patients benefit from an IV to oral switch, which often enables them to leave the hospital earlier than they would otherwise. Hospitals also benefit as oral drugs typically cost less than their IV counterparts. Development of oral agents with greater bioavailability that achieve higher and more consistent serum concentrations has increased adoption of this practice.3
Improving empiric therapy with recommendations based on facility or unit antibiogram. By choosing antimicrobials most likely to be effective for a specific infection in a particular hospital or unit, clinicians can reduce the number of treatment failures, decrease patients’ length of stays and lower costs associated with the use of ineffective agents.
Establishing recommended days of therapy and dosages. Using an electronic surveillance system with clinical decision support can alert pharmacists when patients receive prescriptions that exceed the recommended duration of therapy or require adjustment for renal insufficiency or other factors. These alerts can help eliminate excessive and often counterproductive use of antimicrobials and further cuts pharmacy costs.
Intervening in bug-drug mismatches. Surveillance systems can be programmed to alert pharmacists involved in antimicrobial stewardship when a prescribed agent is inappropriate for infection based on laboratory results, so that the prescriber can be informed of a more effective antimicrobial. These alerts can help produce better outcomes for the patient and conserves both medications and pharmacy budgets.
CDC. Get Smart for Healthcare: Know When Antibiotics Work. National Center for Emerging and Zoonotic Infectious Disease. Division of Healthcare Quality Promotion.
Craig WA, Uman SJ, Shaw WR, Ramgopal V, Eagan LL, Leopold ET. Hospital use of antimicrobial drugs. Survey at 19 hospitals and results of antimicrobial control program. Ann Intern Med. 1978 Nov; 89(5 Pt 2 Suppl):793-5.
Cyriac JM, James E. Switch over from intravenous to oral therapy: A concise overview. J Pharmacol Pharmacother. 2014 Apr;5(2):83-7.