Antimicrobial Stewardship Programs

Antimicrobial stewardship programs (ASPs) are coordinated interventions designed to optimize antimicrobial use, improve patient outcomes, and reduce antimicrobial resistance. The Joint Commission requires hospitals to have antimicrobial stewardship programs, making this a relevant topic for CPHQ candidates.

Core Elements of Stewardship

The CDC has defined seven core elements for hospital antimicrobial stewardship: leadership commitment, accountability, pharmacy expertise, action, tracking, reporting, and education. Leadership commitment ensures adequate resources and authority. Accountability assigns a physician leader, typically an infectious disease specialist, who is responsible for program outcomes.

Key Stewardship Strategies

Programs employ several strategies to optimize antimicrobial use. Prospective audit with feedback involves reviewing antimicrobial orders after they are placed and providing recommendations to the prescriber. Formulary restriction and preauthorization require prescribers to obtain approval before using certain agents. Antibiotic time-outs prompt clinicians to reassess the need for antibiotics after 48 to 72 hours when culture data are available.

Measuring Program Effectiveness

Stewardship programs track multiple metrics to evaluate effectiveness. These include antimicrobial utilization rates (often measured in days of therapy per 1,000 patient days), resistance patterns, Clostridioides difficile infection rates, and clinical outcomes such as mortality and length of stay. Programs should benchmark their data against national standards.

Regulatory Requirements

The Joint Commission standard requires hospitals to establish an antimicrobial stewardship program. CMS Conditions of Participation also mandate antibiotic stewardship activities. State regulations may impose additional requirements. Quality professionals should be familiar with these requirements and ensure organizational compliance.

Multidisciplinary Approach

Effective stewardship requires collaboration among physicians, pharmacists, microbiologists, infection preventionists, information technology specialists, and quality professionals. The quality professional's role includes facilitating data collection, supporting performance measurement, and connecting stewardship outcomes to the organization's overall quality goals.