Care updating pages
If conducted over time, process reviews assess the impact of efforts to improve use.
For interventions that provide feedback to clinicians, it is also important to document interventions and track responses to feedback (e.g., acceptance).
It complements existing guidelines on ASPs from organizations including the Infectious Diseases Society of America in conjunction with the Society for Healthcare Epidemiology of America, American Society of Health System Pharmacists, and The Joint Commission.(6, 31, 32) There is no single template for a program to optimize antibiotic prescribing in hospitals. However, experience demonstrates that antibiotic stewardship programs can be implemented effectively in a wide variety of hospitals and that success is dependent on defined leadership and a coordinated multidisciplinary approach.(33-36) Financial support greatly augments the capacity and impact of a stewardship program and stewardship programs will often pay for themselves, both through savings in both antibiotic expenditures and indirect costs.
The development and spread of antibiotic resistance is multi-factorial and studies assessing the impact of improved antibiotic use on resistance rates have shown mixed results.(97-99) The impact of stewardship interventions on resistance is best assessed when measurement is focused on pathogens that are recovered from patients after admission (when patients are under the influence of the stewardship interventions). what percent of patients develop resistant super-infections) has also been shown to be useful (99) Stewardship programs can result in significant annual drug cost savings and even larger savings when other costs are included.(18, 20, 21, 100) These savings have been helpful in garnering support for antibiotic stewardship programs.
If hospitals monitor antibiotic costs, consideration should be given to assessing the pace at which antibiotic costs were rising before the start of the stewardship program.(101) After an initial period of marked costs savings, antibiotic use patterns and savings often stabilize, so continuous decreases in antibiotic use and cost should not be expected; however, it is important to continue support for stewardship to maintain gains as costs can increase if programs are terminated(30) Antibiotic stewardship programs should provide regular updates on antibiotic prescribing, antibiotic resistance, and infectious disease management that address both national and local issues.(2) Sharing facility-specific information on antibiotic use is a tool to motivate improved prescribing, particularly if wide variations in the patterns of use exist among similar patient care locations.(102) There are many options for providing education on antibiotic use such as didactic presentations which can be done in formal and informal settings, messaging through posters and flyers and newsletters or electronic communication to staff groups.
The AU module is available to facilities that have information system capability to submit electronic medication administration records (e MAR) and/or bar coding medication records (BCMA) using an HL7 standardized clinical document architecture.
To participate in the AU option, facility personnel can work with their information technology staff and potentially with their pharmacy information software providers to configure their system to enable the generation of standard formatted file(s) to be imported into NHSN.(44, 89) As more facilities enroll in the AU option, CDC will begin to establish risk adjusted facility benchmarks for antibiotic use.