Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborative

Abstract

Inappropriate antimicrobial use in hospitalized patients contributes to antimicrobial‐resistant infections and complications. We sought to evaluate the impact, barriers, and facilitators of antimicrobial stewardship best practices in a diverse group of hospital medicine programs. This multihospital initiative included 1 community nonteaching hospital, 2 community teaching hospitals, and 2 academic medical centers participating in a collaborative with the Centers for Disease Control and Prevention and the Institute for Healthcare Improvement. We conducted multimodal physician education on best practices for antimicrobial use including: (1) enhanced antimicrobial documentation, (2) improved quality and accessibility of local clinical guidelines, and (3) a 72‐hour antimicrobial “timeout.” Implementation barriers included variability in physician practice styles, lack of awareness of stewardship importance, and overly broad interventions. Facilitators included engaging hospitalists, collecting real time data and providing performance feedback, and appropriately limiting the scope of interventions. In 2 hospitals, complete antimicrobial documentation in sampled medical records improved significantly (4% to 51% and 8% to 65%, P < 0.001 for each comparison). A total of 726 antimicrobial timeouts occurred at 4 hospitals, and 30% resulted in optimization or discontinuation of antimicrobials. With careful attention to key barriers and facilitators, hospitalists can successfully implement effective antimicrobial stewardship practices. Journal of Hospital Medicine 2016;11:576–580. © 2016 Society of Hospital Medicine

The Barriers in the implementation of Antimicrobial Stewardship Programs: A systematic Review

“…Social barriers such as perception of resistance, mistrust in antibiotic guidelines, and the skepticism of antimicrobial stewardship importance also affect the application of ASPs. (6,11,15) Other studies reported that sociocultural beliefs, logistic barriers, and ethical concerns put impact in the implementation of ASPs (8,13).…”

“…One of the significant prescribing barriers is hierarchical structures (6,11,17). The study reported that the hospital hierarchies and consultation etiquette result in conflict between several physicians.…”

“…The successful implementation of Antimicrobial stewardship programs needs careful attention to the main barriers (6). There are many hurdles for antimicrobial stewardship programs which lead to the inappropriate prescription.…”

Implementasi Antimicrobial Stewardship Program di Kawasan Asia: Sebuah Kajian Sistematis

“…Sebagai contoh, belum tersedianya dokter atau apoteker yang memiliki spesialisasi infeksi tidak menjadi penghambat keberhasilan implementasi ASP seperti yang telah dibuktikan pada beberapa artikel penelitian. 66,72 Selain itu, kerjasama antarinstitusi dapat dilakukan untuk mengatasi keterbatasan dalam mengimplementasikan ASP, dan kerjasama tersebut tidak terbatas antarinstitusi kesehatan saja, tetapi juga dapat berupa kerjasama antara institusi kesehatan dan institusi pendidikan. 73 Proses identifikasi bentuk dan teknis kerjasama antarinstitusi perlu dilakukan agar implementasi ASP dapat memberikan manfaat bagi seluruh pihak yang terlibat dalam kerja sama.…”

Expanding Existing Antimicrobial Stewardship Programs in Pediatrics: What Comes Next

“…Hospitalists can likewise be vital partners in stewardship efforts, because their discipline is expanding rapidly, and they often are involved with quality improvement efforts and the efficient use of healthcare resources. A previous multisite hospitalist collaborative successfully enhanced antimicrobial documentation, accessibility to local guidelines, and implementation of a 72-hour antibiotic timeout [75]. The Vermont Oxford Network's Newborn Improvement Collaborative for Quality is an interdisciplinary association that has focused on antimicrobial stewardship for its 2016 and 2017 organization goals [76].…”