What Makes a Successful Antibiotic Stewardship Program?

Antibiotic stewardship programs (ASPs) are the way to safeguard the antibiotics that are still effective, but what makes such a program a success?

As recently as September 2017, WHO declared that too few antibiotics are under development to combat multidrug-resistant infections.¹ While new drugs are needed, we must safeguard the ones that are still effective. Efficient ASPs are the answer.

Kristi Kuper, PharmD, BCPSThe CDC collects data on hospital ASPs annually.² The latest report found that more than half of U.S. hospitals do not meet the CDC’s seven core elements for ASPs, which are included in the suggested framework in the Joint Commission Medication Management standards and referenced in the proposed update to Centers for Medicare and Medicaid Services (CMS) Conditions of Participation, currently under review.³ Additional research⁴ conducted by Vizient and Virginia Commonwealth University corroborates this.

This significant gap threatens to undermine progress toward securing the future of antibiotics and increases the risk for multidrug-resistant infections. By understanding factors associated with the highest-performing ASPs, as well as low-performing or nonexistent ones, we can determine how best to support hospitals in developing successful stewardship practices.

Our research indicates academic medical centers are far likelier to have a high-performing ASP compared to smaller, independent hospitals.⁴ Academic medical centers and health systems in densely populated areas typically have the infrastructure. access to expertise, and resources that smaller hospitals may lack. Other research⁵ confirms the significant barriers smaller hospitals face.

Fortunately, there are ways to bridge this stewardship gap between large and small hospitals:

• Involve leadership. We found that 45% of hospitals did not have a written statement of support for antibiotic stewardship,⁴ despite the CDC's acknowledgement that formally engaging leaders is critical.⁶

• Compensate physicians for participation. Of  the high-performing ASPs we identified, 76% compensated physicians for participating.⁴ Telehealth services will be a resource available to more hospitals, especially in rural areas.

• Engage other health-care professionals within the hospital. Any professional who interactswith antibiotics can make a difference in their use. Nurses  who interact with every patient, for example, can be trained to perfrom evaluations about a patient’s antibiotic use to prompt additional assessments for antibiotoic necessity.⁷

• Track and report antibiotic use. Many hospitals now transmit their antibiotic usage data to the CDC's antibiotic Use Module,⁸ which can help generate reports and benchmark performance against other hospitals.

Many hospitals will need to catch up when the changes in CMS Conditions of Participation take effect.

However, we should not expect community and critical access hospitals that may have limited resources to go it alone.  Health professionals and policy makers must provide a clear path forward for stewardship in all hospitals

References

1. World Health Organization. The world is running out of antibiotics, WHO confirms. Available at http://bit.ly/2xgNgeQ. Sept. 20, 2017.
2. Centers for Disease Control and Prevention. Inpatient Antibiotic Stewardship Data, Patient Safety Atlas. Available at http://bit.ly/2iQfvxL. March 3, 2016.
3. Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. Available at http://bit.ly/2gZFfXS. Feb. 23, 2017.
4. Vizient, Inc. Survey of Hospital Antibiotic Stewardship Practices Reveals Room for Improvement. Available at http://bit.ly/2z3XDDt. June 14, 2017.
5. Stenehjem E, et al. Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions. Clin Infect Dis. Aug. 15, 2017; 4: 691-696.
6. Centers for Disease Control and Prevention. Save Money with Antibiotic Stewardship. Available at http://bit.ly/2gZzk4U. July 18, 2017.
7. Olans RN, Olans RD, DeMaria A. The critical role of the staff nurse in antimicrobial stewardship-Unrecognized, but already there. Clin Infect Dis. 2016; 1: 84-89.
8. Centers for Disease Control and Prevention. Antimicrobial Use and Resistance (AUR) Module. Available at http://bit.ly/2zV9FON. March 2017.