6. Reporting: Information on antibiotic use and resistance should be regularly reported to doctors, nurses, and relevant staff. Summaries of issues that come up during preauthorizations or prospective audit and feedback can help providers improve prescribing, especially when there are significant variations in prescribing patterns among similar care areas. Peer comparisons can be a particularly effective tool to improve antibiotic prescribing in outpatient settings. 11 7. Education: Clinicians should be educated on antibiotic resistance and optimal prescribing. Education should not be used alone as an antibiotic stewardship intervention; pairing education with outcome measurement and interventions has been shown to be most effective. Case-based education presented in person to providers and relevant staff can help identify alterations in antibiotic treatment that could have been made and encourage discussion on appropriate antibiotic use. 3 Seven Core Elements of a Successful Hospital Antibiotic Stewardship Program 1. Commitment from leadership
BEFORE MOVING ONTO THE NEXT SECTION, PLEASE COMPLETE CASE STUDY 1.
• Designing a means for reporting antibiotic stewardship activities and outcomes and sharing this information with facility leaders. • Training stewardship leaders on antibiotic stewardship. Drug Expertise Utilizing drug knowledge to improve antibiotic use is critical to the success of an antibiotic stewardship program. Implementation strategies for the core element of drug expertise include : 3 • Designating a pharmacist leader of the antibiotic stewardship program, ideally someone who is on site at least part time. Adding antibiotic stewardship activities as part of the job description of the pharmacist leader can help define stewardship activities and ensure that stewardship leaders have set aside time to spend on developing and maintaining the stewardship program. • Appointing a physician leader to support the antibiotic stewardship program, ideally someone who is on site at least part time. • Offering training on antibiotic stewardship. Action With a plethora of evidence-based interventions available to improve antibiotic use, decisions on which ones to utilize should be based on the facility’s needs, which can be established through both discussing needs with providers and reviewing local antibiotic use information.
Implementing Core Elements
Commitment from Leadership and Accountability
Commitment from leadership is critical to ensuring that resources are allocated to support stewardship programs. Leaders—such as the pharmacy director, nursing directors, and the chief medical officer—should be involved in the creation of strong programs that engage staff in these departments. 3 ensure commitment from leadership and accountability can include: 3 • Approving policies to create or expand antibiotic stewardship programs that include the seven core elements. • Issuing a formal statement on the importance of the antibiotic stewardship program to staff. • Issuing a statement from hospital leaders to providers and patients describing the facility’s commitment to appropriate antibiotic use. • Incorporate antibiotic stewardship activities into ongoing patient safety and quality improvement programs. • Designating a physician with a role in hospital Implementation strategies to leadership, such as the chief medical officer, to be held accountable for outcomes related to the antibiotic stewardship program.
2. Accountability 3. Drug expertise 4. Action 5. Tracking
6. Reporting 7. Education
Case Study 1 Instructions: Please read through the case study below and consider the questions that follow. (ANSWER KEY AND RATIONALE IS DISPLAYED AT THE BOTTOM OF THIS EXERCISE)
Valley Hospital is a 240 bed facility that is concerned about the overuse of antibiotics in its community. They are interested in reducing their impact on antibiotic overprescribing, so they are setting up an antibiotic stewardship program. The hospital leadership has designated a physician and pharmacist to lead the antibiotic stewardship program. They have found that the facility has a high rate of prescribing inappropriate antibiotics to treat UTIs, and they would like to address this issue to improve patient care. 1. Which of the following interventions would be most appropriate to assess antibiotic prescribing after an antibiotic has been prescribed to treat a UTI? a. Prospective audit and feedback b. Preauthorization c. Facility-specific treatment guidelines d. Tracking the rates of Clostridium difficile infections 2. Which of the following members of an antibiotic stewardship team is typically involved in facility-wide monitoring and infection prevention measures such as auditing, analyzing, and reporting data? a. Medical director b. Laboratory staff c. Infection preventionist d. Nurses 1. Answer: A - Rationale: Prospective audit and feedback, or external reviews of antibiotic prescribing conducted by an antibiotic use expert, occurs after the antibiotic has been prescribed and can address facility issues with antibiotic prescribing. 2. Answer: C - Rationale: Infection preventionists and epidemiologists are typically involved in facility-wide monitoring and infection prevention measures such as auditing, analyzing, and reporting data; monitoring and reporting resistance and trends; educating staff; and implementing plans to improve antibiotic use.
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