14 Key Success Factors in Antibiotic Stewardship Programs

This checklist will help determine whether your program is achieving optimal results

The problem of drug-resistant bacteria is a bit like the problem of world hunger: everyone agrees that it’s a huge concern, but too few organizations are taking meaningful steps to solve it.

It’s not enough simply to understand the scope of the problem. Numerous healthcare systems have on-staff infectious disease experts who thoroughly understand the science of antibiotic resistance and its implications. Instead, healthcare organizations must take immediate action to change behavior that has led to the largest community health crisis of this century.

Such action requires both humility and diligence. Large medical centers can learn much from modest critical access hospitals, which often lead the way in effective implementation of antibiotic stewardship best practices. Moreover, health system executives can learn from organizations that have achieved specific goals in antibiotic-resistant bacteria reduction.

The following 14-point checklist can help you determine whether your organization has an Antibiotic Stewardship Program (ASP) that ranks with the best or needs to make improvements:

  1. Are your pharmacy antibiotic volumes and costs decreasing – and when was that information last reported to executive management and the board of directors?
  2. Is your organization experiencing outbreaks of infections – and incurring penalties for hospital readmissions and hospital-acquired infections?
  3. Has your organization been sued due to antibiotic-resistant infection(s)?
  4. Is your methicillin-resistant Staphylococcus aureus (MRSA) rate decreasing?
  5. Is your Clostridium difficile rate decreasing – and is it less than the national average of around 7.5 cases per 10,000 patient days?
  6. Are you experiencing any carbapenem-resistant enterobacteriaceae (CRE) infections – and is that number declining?
  7. Are “last ditch” reserve antibiotics being used in your organization (g., Colistin)?
  8. Do you have an internal team tasked with changing prescribing habits across your organization?
  9. Is your ASP team educating the medical staff about the human microbiome as it relates to an effective ASP strategy?
  10. Has your CEO requested an antibiogram from the head of pharmacy? (An antibiogram is a community-wide measurement of how microorganisms respond to a battery of antimicrobial drugs.)
  11. Have you met with leaders from health systems that are achieving excellent results in their ASP programs?
  12. Do you have a detailed strategy for preserving current antibiotics for future generations?
  13. Does your ASP program conduct community education about the dangers posed by antibiotic-resistant bacteria and the behavioral changes needed to combat them? The easiest way to get started is to introduce community members to the “Voices In America” program on antibiotic stewardship hosted by James Earl Jones. It provides essential information in an accessible way – something community members can easily understand.
  14. Is your board “on board?” Most hospital boards include local business and community leaders who have a strong interest in keeping their neighbors safe and healthy. Do your trustees understand the community health implications of antibiotic overuse?

Below are some sobering reasons why immediate action is needed:

Today’s efforts have a multi-generational impact.

Countless Baby Boomers may never experience a wide-scale outbreak of antibiotic-resistant infections, but their children and grandchildren may not be so lucky. The actions we take today are critically important for future generations.  History will judge us harshly if we fail to take prudent steps to ensure the long-range effectiveness of antibiotics.

In the U.S., more people die each year from MRSA than AIDS.

This has been a reality since 2005, and medical epidemiologists at the Centers for Disease Control and Prevention report that MRSA cases involving children are on the rise.

Healthcare organizations’ legal exposure is increasing.

One Texas hospital and physician had to pay $7.5 million to a patient who was given eight different antibiotics, none of which were effective against MRSA. The patient developed gangrene, and underwent both leg and arm amputations.

Quality issues create public relations nightmares.

A hospital with a stellar quality record can have its reputation tarnished overnight following a CRE outbreak. Last year, the prestigious Ronald Reagan UCLA Medical Center in Los Angeles had a CRE outbreak that killed two patients and exposed more than 180 others to the infection. It’s hard to quantify the long-term financial and reputational repercussions of this type of bad publicity.

The following is some encouraging news.

Drug-resistant infections are a global problem with a local solution.

This is one instance when grassroots efforts can make a big difference. For example, there are portions of South Dakota that are experiencing an extremely low number of antibiotic-related infections – while other parts of the state are witnessing alarming rates.

ASP programs can be good for a hospital’s bottom line.

The cost of caring for Clostridium difficile patients can be significant when you include the time and expense of quarantining them and disinfecting their rooms after they’re discharged.

ASP programs can improve quality scores.

Following a MRSA infection, discharged patients have a 28% risk of being readmitted within 30 days.  No patient wants to be admitted (or readmitted) to a facility that has had recurring problems with antibiotic-resistant infections or hospital-acquired infections. A robust ASP program can help keep your organization’s quality scores on the rise.

Beginning next year, the Centers for Medicare & Medicaid Services will require all hospitals to implement an ASP program in order to continue Medicare participation. However, the sad fact is that many of those efforts will be programs in name only.

Fifteen years ago, the Institute of Medicine published Crossing the Quality Chasm, a book that urged clinicians to make continuous progress in quality care.  Unfortunately, we’re seeing a lot of outcome ineffectiveness in ASP programs, and that’s not acceptable. Our objective should not simply be to pass a Joint Commission review, then pat ourselves on the back. Our goal should be zero antibiotic-resistant infections in our communities.

By sharing best practices and keeping the welfare of our children and grandchildren in mind, we can achieve that goal, one community at a time.

James M. Keegan, MD, is an infectious disease specialist who directs the Antibiotic Stewardship service line at PYA (Pershing Yoakley & Associates), a healthcare consulting firm serving clients in all 50 states.

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