Roy Boukidjian, MSN, PHN, System Director of Infection Prevention at San Francisco-based Dignity Health, said keys to the success of its ASP are commitment to start and consistency to finish.
The program has: modified electronic health record orders to require providers to establish why an antibiotic is being used; implemented antibiotic utilization ratio software for reporting lengths of therapy (DOT) and resistance patterns to the CDC for comparison against other hospitals; and created dashboards to reduce DOT system wide and metrics to measure DOT improvement. Dignity showed a 7% reduction in antibiotic usage in October compared to the first half of 2017.
Oversight, Education, Reminders
“We don’t always know the optimal way to find the right antibiotic to use with a specific disease, which can lead to over prescribing,” said Aaron Glatt, MD, Chair of Medicine at South Nassau Communities Hospital in New York and an epidemiologist. “When it isn’t clear, we have to rely on clinical judgment.”
The hospital put a stewardship program in place in 2013, which put clinical pharmacists specially trained in infectious disease on every floor, with access to infectious disease physicians. Glatt said the hospital has shown a decrease in overall use of antibiotics and a turn-around in inappropriate use.
“The responsibility falls on everybody, “Glatt said. “To have a successful program, you need oversight, education, physician reminders, and follow up.”
Despite efforts to reduce antibiotic resistance and overuse, statistics about prevention do not bode well. Even though an estimated 50% of antibiotics are prescribed inappropriately, only 40% of U.S. hospitals have an ASP, according to the CDC.