According to the Centers for Disease Control and Prevention (CDC), drug-resistant bacteria cause two million illnesses and 23,000 deaths annually. The National Quality Forum, a nonprofit organization, has convened more than 25 experts and national stakeholders from the public and private sectors to develop Antibiotic Stewardship in Acute Care: A Practical Playbook. The publication is designed to offer practical strategies for implementing high-quality antibiotic stewardship programs in hospitals nationwide.
In 2014, the CDC recommended that all acute-care hospitals implement antibiotic stewardship programs (ASPs) in order to meet the urgent need to improve antibiotic use in hospitals. The Playbook focuses on the CDC’s seven core elements of ASPs, as follows:
- Leadership Commitment: Dedicate necessary human, financial, and information technology resources.
- Accountability: Appoint a single leader responsible for program outcomes who is accountable to an executive-level or patient quality-focused hospital committee. 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, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e., “antibiotic time out” after 48 hours).
- Tracking: Monitor process measures (e.g., adherence to facility-specific guidelines, time to initiation or de-escalation), impact on patients (e.g., Clostridium difficile infections, antibiotic-related adverse effects and toxicity), antibiotic use, and resistance.
- Reporting: Report the above information regularly to doctors, nurses, and relevant staff.
- Education: Educate clinicians about disease-state management, resistance, and optimal prescribing.
The Playbook details potential challenges at each step, based on the experience of experts involved in the process. For smaller rural hospitals, the publication offers suggestions on how to acquire needed resources that may not be available locally.
The Playbook focuses on acute care and does not address guidance for antibiotic stewardship in other settings.
Source: National Quality Forum; May 2016.