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What to Include in an Antimicrobial Stewardship Program Proposal

If you want to implement an antimicrobial stewardship program at your facility, you’ll need to obtain support from hospital administration and funding. You’ll need to write a proposal that explains why your hospital needs an antimicrobial stewardship program (ASP), the elements you expect to include and what you hope to accomplish by implementing one.

As you start, consider including these topics in your ASP proposal:

  1. Background: Set the stage: How much does your hospital currently spend on antimicrobials? You may also want to touch on the indirect costs associated with healthcare-associated infections and treatment failures. Explain the indirect costs of antimicrobial resistance as well and the role inappropriate use of antimicrobials plays in increasing resistant pathogens. Include data on increasing resistance in your facility if you have it. You can also provide a brief summary of the increase in methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C. Diff.), vancomycin-resistant enterococci (VRE) and other relevant pathogens along with their rising mortality rates and costs for treatment.

  2. Benefits: Discuss how antimicrobial stewardship programs improve patient safety, enhance quality of care and reduce costs. You can pull numbers and specific benefits from published case studies and industry data. Typical benefits include reduced pharmacy costs, lengths of stay and mortality.

  3. Program elements:

    Staff—Who will staff the program? Will you need to hire an infectious disease trained physician or pharmacists? Will the hospital need to pick up a percentage of the program directors’ salaries if they are redirected away from patient care? Will you use students or residents to supplement staff? Who else will devote significant time to the program—a microbiologist, IT professional, infection preventionist, nurse? How will team members interact and support each other? What are they authorized to do?

    Technology—What system will you use to support the program? Does the hospital already have a surveillance system or clinical decision support system? How will you monitor prescriptions, infections and outcomes?

    Policies—Most ASPs rollout policies sequentially to keep staff from becoming overwhelmed and increase the likelihood of success. What will be your first policies—formulary restriction, IV-to-PO conversion, prospective review by the pharmacist with direct intervention, guidelines for indication/drug/dosage/duration?

    Education—How will you educate staff and clinicians on the importance of antimicrobial stewardship? What programs will you introduce to change physician prescribing behavior and encourage optimal prescribing practices? How often will you offer or require updates? Who will see and discuss reports showing changes in prescribing patterns and adoption of other interventions? How will you share information about changes in your facility’s antibiogram?

    Measurement and Reporting—What metrics will you track? To whom and how often will they be reported? Most hospitals monitor some combination of antimicrobial use, antimicrobial costs, prevalence of resistant organisms, lengths of stay for relevant DRGs, adverse effects, mortality and C. diff. infection rates. They also usually measure the number of ASP interventions, the acceptance rate for those interventions overall and by prescriber, the kinds of interventions, and prescribing patterns of prescribers.

  4. Goals: What do you want to accomplish with the ASP? You may have multiple goals, including optimizing antimicrobials to improve patient outcomes and reduce costs; streamlining antimicrobials; converting intravenous drugs to oral administration more consistently and earlier; improving documentation of indication, drug, dosage and duration; implementing automatic stops for antimicrobials prescribed without clinical confirmation in 48 hours. If you have specific targets for percentage improvements or dollars saved, include these targets as well.

  5. Scope: Will you introduce the ASP throughout the hospital from the beginning or start in one unit and grow in a phased approach?

  6. Future plans: If you plan to phase in the ASP, when and how will you proceed to the next step? Do you plan to solicit outside assistance or funding.

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