Representatives of the National Quality Forum are trying to make it easier for hospitals to install antibiotic stewardship programs by offering a playbook for doing so that fits all hospitals’ circumstances.
Recognizing that a one-size-fits-all approach won’t work for creating programs making better use of antibiotics, the playbook — “Antibiotic Stewardship in Acute-care Hospitals: A Practical Playbook from NQF” — was designed for all size hospitals and for different levels of stewardship.
The playbook couldn't be more timely, following word that a U.S. resident has been found to carry a form of E. Coli that is resistant to the antibiotic used to treat it in "last resort" situations.
The guide arrives in advance of “significant levers” coming down the pike that will give hospitals incentive to develop a strong stewardship program, says Sara Cosgrove, M.D., director of the antimicrobial stewardship program at Johns Hopkins Hospital, where she also is associate professor of medicine, division of infectious diseases, at a telebriefing for the press. The Centers for Medicare & Medicaid Services is planning to make stewardship part of the Conditions of Participation in the Medicare program, and the Joint Commission also is developing a standard, Cosgrove says.
“All hospitals need to be concerned about who’s running their stewardship program, (and) how their stewardship is supported, she says.
The issue is important because microbial infections are increasingly becoming immune to the current lineup of antibiotics, and some in health care are struggling to reduce inappropriate use of the drugs.
“We don’t do a good job of using antibiotics in the health care field,” says Arjun Srinivasan, M.D., associate director for healthcare-associated infection prevention programs in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases, at the telebriefing.
Included are seven strategies specifically for hospitals to install a successful antibiotic stewardship program:
Leadership Commitment: Dedicate necessary resources.
- Accountability: Appoint a single leader responsible for program outcomes ; experience with successful programs shows that a physician leader is effective.
- Drug Expertise: Appoint a single pharmacist leader responsible for working to improve antibiotic use.
- Action: Implement at least one recommended action.
- Tracking: Monitor process measures, impact on patients, antibiotic use, and resistance.
- Reporting: Provide the above information regularly to doctors, nurses, and relevant staff.
- Education: Keep clinicians informed about disease state management, resistance, and optimal prescribing.
Part of the problem is that there is a lack of resources for smaller hospitals, which in general are not as far along in creating stewardship programs as larger hospitals are, according to Srinivasan.
Nonetheless, it’s important that they do so. “There is abundant evidence that these antibiotic stewardship programs are able to help us reduce clostridium difficile, antibiotic resistance, and improve patient outcomes and save money at the same time,” Srinivasan says.