In this article an infectious diseases pharmacist with over a decade of experience in the field discusses tips for advancing antimicrobial stewardship practice.
Authored By: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
Article Posted 27 April 2022
Antimicrobial stewardship programs (ASPs) continue to be instrumental in the fight to preserve our precious antimicrobial drugs. In the years prior to COVID-19, ASPs were beginning to get comfortable in the acute care setting with a seemingly inevitable expansion across the healthcare landscape on the horizon. The pandemic has certainly stifled progress for ASPs as resources were prioritized towards the new infectious threat of SARS-CoV-2 and we battled back by developing responses in and out of the hospital setting. It has challenged us to be creative. It has pushed us to be innovative. It continues to impact our ability to address the tidal wave that is antimicrobial resistance.
In providing evidence-based care, standardization combined with quality assurance is a sure-fire way to reach checkpoint goals. A component of this includes building programs which function as a result of their structure and are not dependent on a particular individual with a specialized skillset. Yet a theme of antimicrobial stewardship is inter-facility variation in needs based upon patient population, size, geographic location, staff skillsets, funding, lab equipment, and more. To direct program growth, risk assessments with strategic planning can be crucial, as we have seen in the world of infection prevention and control. There is simply too much to do and too little time or resources to get it done, so we need to prioritize and learn from experience.
One key to success for ASPs is relationship building, which enables program leads to become informed and direct efforts more efficiently. Trust in the stewardship program is necessary for growth. One positive thing the pandemic has brought is enhanced visibility for the ASPs through new relationships.
As ASPs seek to pivot in reaction to the ongoing pandemic, program expansion should be considered, but how to take the next step can be unclear. With that in mind, the goal of this article is to identify and discuss a few options for advancing antimicrobial stewardship programs.
1. Start a question of the week
Many of us answer the same questions over and over again. Why not take these questions, summarize the answer with some references, and circulate them with your team?
Not only does a question of the week serve to facilitate education on clinically meaningful topics, it also creates visibility for the ASP and can build credibility for it. This is an item that can be scaled up or down, made formal or informal, and be achieved through a variety of formats. It even can be something to couple with drug information questions completed by trainees with the guidance of their preceptors.
2. Adopt new technology
Oh what’s that shiny new app you have there? Bringing in new technology can help extend the reach and visibility of ASPs. One program that has many of my colleagues talking lately is Firstline (formerly Spectrum), which offers a platform to help disseminate guidelines and be a contact point between the ASP and frontline providers.
ASPs that have implemented Firstline have observed up to an additional 18% improvement in prescribing appropriateness. Appropriate prescribing can reduce broad-spectrum antibiotic and overall antimicrobial use, leading to substantial direct and indirect cost savings.
Other positive findings include reduced healthcare-associated infections, such as C. difficile cases, and improvement in common stewardship problems such as the inappropriate treatment of asymptomatic bacteriuria.
3. Develop a new way to recognize success stories
Recognition initiatives are not just about uplifting individuals (which is important mind you). Staff recognition can also foster growth of the team by showing that colleagues are competent and capable people for whom we should all be proud to work with.
Tell me a fact and I will learn, tell me the truth and I will believe, but tell me a story and it will live in my heart forever. Simple recognition may be a great next step for a growing ASP.
Recognition can include a physical token and should be visible to peers. Having a fun name for the recognition may be something to consider, which may further drive chatter and positive feedback towards the ASP within which all staff should be engaged. This is something that can be made into a big deal for the institution or kept within a department. There is a lot of flexibility on this and you may have to navigate some institutional politics plus be mindful to avoid favoritism, but good vibes tend to create more good vibes. After all, a rising tide lifts all boats!
4. Establish a short standing meeting with your key partners
More Zoom calls??? Who has got time for this, right!?!
Well, sometimes it is about working smarter and not about working harder. With most people accustomed to Zoom, it can be much more functional to have a weekly or monthly touchpoint with key stakeholders such as infection prevention, lab, quality, nursing, department leaders, influential specialist providers, media, or others (depending upon where your goals lay).
This kind of step forward for the ASP does not have to be forever and can be a trial and error type of deal. Staying aligned on institutional priorities is difficult as people focus on what is in front of them and see the world through their own eyes. Connecting with your colleagues may be a way to create synergy and set strides in unison to enable the organization to go further, faster.
5. Use social media
How can we not talk about social media when it comes to ASPs? Twitter has revolutionized how many of us find and share information during COVID-19 times. Social media can be used for advertising, networking, getting ideas (like #ASPchat), and more. After you identify what your goal is, the sky is the limit! Just remember to follow your institutional policies and guidelines.
On the topic of social media and ASPs, the Firstline Community, a global network for ID and ASP professionals (from the same people mentioned in #2 above) is pretty neat and may be of interest to people who read this blog post. The free platform allows for longer-form and more in-depth conversations, and the private membership ensures you are receiving trusted information from verified sources. In particular, it is a noteworthy platform for those who are more hesitant about engaging on broad social media channels.
I could not stop at just five, so here are a few more just for fun…
- Start a research project with your team and publish your work!
- Develop a fun mascot to garner attention. Examples include Scot with an ASCOT from University of Maryland, Ugotabug from University of Miami, or the Guide for Optimal Antimicrobial Therapy (GOAT) from the ASP in Hennepin Healthcare in Minneapolis.
- Engage with learners (i.e., students, interns, residents) to develop and expand ASP fundamentals
- Engage with your community by bringing a patient or non-health voice into your collaboratives
I hope you found this helpful if not inspiring to make the next step in expanding your stewardship efforts! If you have an item not shared here, feel free to shoot a message to IDstewardship@gmail.com.
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