For nearly a decade now, antimicrobial stewardship has been a hot topic throughout the country as hospitals work to comply with recommendations from numerous national and international organizations. In 2014, the Joint Commission (TJC) began requiring any hospitals which it accredits to establish a formal antimicrobial stewardship program (ASP). According to a 2018 Centers for Disease Control and Prevention (CDC) report, 85% of U.S. hospitals were meeting all seven of their recommended core elements. This is encouraging news, particularly, as monies from governmental insurance providers may also soon be tied to these important programs. Though the number of programs continues to grow, there is still much work to be done.
In the face of the current COVID-19 pandemic, antimicrobial stewardship practices continue to show their benefit. As new therapies and data become available, healthcare systems must ensure that they are identified, assessed, and utilized in a judicious and appropriate manner. ASPs are ideally suited to this process and should be expanded during this time to monitor and evaluate the use of antimicrobials and other potential treatment modalities.
Hospital leaders whose facilities lack an ASP may be unsure where to begin or what resources are needed to develop a successful program. In my experience, there are three essential subjects for hospital administrators to keep in mind when starting a new ASP or optimizing an existing program.
Tear Down the Silos
Often when starting an ASP hospital leaders default to those team members who first come to mind (i.e., doctors, nurses and pharmacists). However, it has been shown that by taking a more interprofessional approach, ASPs can have increased success and open doors which may not have even found otherwise. One key, and often overlooked, group is the Environmental Services Department who clean and disinfect patient rooms and, therefore, must understand that special measures are required when dealing with particularly virulent infections such as Clostridium difficile (aka C. diff.) and other high-risk situations.
Capture the Right Data
In their 2019 guideline, “Core Elements of Hospital Antimicrobial Stewardship Programs,” the CDC encourages all hospitals to collect and report monthly antibiotic days of therapy (DOT), a measure of antibiotic utilization which can be analyzed in aggregate and by specific agents and patient care locations to provide benchmarking and other key information for hospitals locally and at the state and national level. Given how important financial success is to any health care system, knowing how much is being spent on antimicrobials, as a whole, and key high-cost items specifically is also an essential data point to monitor for any successful ASP. In addition to demonstrating return on investment, this data may also be good indicators of how the program can help to decrease overall length of stay by ensuring appropriate durations of therapy, choice of antimicrobials, and transitioning of patients to oral treatments whenever possible.
Communication is Key
It is essential to not only keep ASP members informed regarding outcomes and data from the program and current best practices, but, also to share those points with other members of the health care team and community. Distributing communications, such as newsletters, on a regular basis and inviting ASP members to present at key committee meetings are two quick and easy ways to get the word out about the importance of ASP and the great work being done in your health care system.
Quick face to face meetings with key stake holders, such as nurses, both to disseminate and gather information may also be an effective way to ensure bidirectional communication is occurring.
A successful ASP requires effort and buy-in from every hospital department, particularly, leadership. Without hospital leadership’s support, the momentum and overall goal will fall short. By utilizing these tips, hospital administration can align a team with a plan to develop and implement a successful ASP that will make a significant impact, not only on your organizations bottom line, but on overall patient outcomes and community health.
by Paul T. Green, Pharm.D., MHA, DPLA, BCPS System Director of Pharmacy, CompleteRx / Upper Allegheny Health System