98 Survey of Antimicrobial Stewardship Practices

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Lauren D. Nadkarni, BS , Tufts Medical Center, Boston, MA
Kenneth R. Lawrence, PharmD , Tufts Medical Center, Boston, MA
Lisa Davidson, MD, MS , Tufts Medical Center, Boston, MA
Caren Garber , Tufts Medical Center, Boston, MA
David R. Snydman, MD, FACP , Tufts Medical Center, Boston, MA
Jack Evans, RPh, MS, MBA , Yankee Alliance, Andover, MA
Shira I. Doron, MD, MS , Tufts Medical Center, Boston, MA

Survey of Antimicrobial Stewardship Practices

Background:   There is a growing necessity in healthcare facilities to monitor and ensure the appropriate use of antimicrobials to improve patient outcomes.  The healthcare community lacks metrics about stewardship practices including which methods are most successful and efficient and what proportion of hospitals have a formal management strategy.

Objective:        To assess stewardship methods for antimicrobial use, resistance, and expenditures; barriers to successful implementation of Antimicrobial Stewardship Programs (ASPs); and the perceptions of participants regarding the success of ASPs.

Methods:         We conducted a survey of Yankee Alliance healthcare providers about their experience with ASPs.

Results:            Institutions with an ASP (42.9%) tended to have more admissions annually (60% > 5000 and 20% < 5001), produce an antibiogram (100%), and have an ID consult service (93.3%).  The mean yearly antimicrobial expenditure for antibacterials and antifungals was $1.138 million.  All ASP teams included an ID physician but ID/clinical pharmacists, clinical microbiologists, and infection control professionals were also common.  Only 13.3% had an ID fellowship program.  73.3% of the institutions did not have a pharmacist dedicated to the management of antimicrobials.  Most ASPs combined “front end,” “back end,” automatic stop order, required ID consult, verbal approval, and antibiotic restriction approaches.  The most frequent stewardship techniques were parenteral to oral conversion (86.7%), guidelines and clinical pathways (80%), and a closed formulary (80%).  Success was frequently measured by expenditures.  73.3% reported physicians at their institutions agreed with the policies.

Institutions without an ASP (57.1%) tended to have fewer admissions annually (40% > 5000 and 40% < 5001) and not be teaching hospitals.  The mean yearly antimicrobial expenditure was $497,000.  Of these institutions, 90% had no ID pharmacist, 95% had no ID fellowship program, and 65% had no formal educational strategies for appropriate antimicrobial use.  However, 70% had an ID consult service and 90% had an antibiogram.  Despite not having an ASP, most institutions had automatic stop orders and/or used a “back end” approach (both 50%) in addition to using parenteral to oral conversion policies and having closed formularies (both 70%).  Only 40% reported physicians at their institution agreed with the policies.  Of institutions without an ASP, 60% had considered implementing a program.  The most common barrier to implementation was staffing constraints. 

Conclusions:   Institutions with an ASP had more admissions, proportionally higher antibiotic budgets, and were more likely to have an ID fellowship program and/or pharmacist. These hospitals had implemented several formal education and antimicrobial use policies and had a higher perceived acceptance of the ASP initiative by other physicians.