Table 1.
Antibiotic Stewardship Program Interventions and Policies in the Michigan Hospital Medicine Safety Consortium (N = 46 Hospitals)
| Question | Hospitals, N (%) |
|---|---|
| Stewardship Collaboration (“Key Support” Groups Under “Accountability” CDC Core Element) | |
| Infection Prevention and Healthcare Epidemiology | 41 (89%) |
| Microbiology (Laboratory) | 39 (85%) |
| Infectious Diseases Physician | 37 (80%) |
| NonInfectious Diseases Physician | 36 (78%) |
| Quality Improvement | 35 (76%) |
| Information Technology | 31 (67%) |
| Nursing | 17 (37%) |
| Stewardship Interventions (“Action” CDC Core Element) | 46 (100 %) |
| Policies that Support Optimal Antibiotic Use | |
| Any Policy Related to Antibiotic Documentation | 37 (80%) |
| Require Documentation of Antibiotic Dose | 36 (78%) |
| Require Documentation of Antibiotic Indication | 21 (46%) |
| Require Documentation of Intended Antibiotic Duration | 8 (17%) |
| Broad Stewardship Interventions | |
| Restricted Formulary for Some Antibioticsa | 42 (91%) |
| Prospective Audit and Feedback for Some Antibiotics | 41 (89%) |
| Preprescription Approval (Prior Authorization) for Some Antibiotics | 36 (78%) |
| “Antibiotic Timeout” to Review Antibiotics at 48–72 hours | 6 (13%) |
| Pharmacy (or Electronic Medical Record) Interventions | |
| Antibiotic Dose Adjustments for Organ Dysfunction | 45 (98%) |
| Automatic Changes from Intravenous to Oral in Certain Situations | 37 (80%) |
| Antibiotic Dose Optimization for Organisms with Reduced Susceptibility | 34 (74%) |
| Alerts for Unnecessarily Duplicative Therapy | 31 (67%) |
| Time-Sensitive Automatic Stop Orders | 24 (52%) |
| Facility-Specific Treatment Recommendation for Any Infection | 45 (98%) |
| Any Syndrome-Specific Intervention | 32 (70%) |
| Other Stewardship Interventionsa | |
| Order Sets that Incorporate Facility-Specific Treatment Recommendations | 42 (91%) |
| Order Sets Contain Decision-Support | 28 (61%) |
| Review of Outpatient Antibiotic Orders Before Discharge | 8 (17%) |
| Antibiotic Monitoring (“Tracking” CDC Core Element) | 46 (100%) |
| Monitor Facility-Wide Antibiotic Prescribing | 38 (83%) |
| By Direct Expenditure (purchasing costs) | 30 (65%) |
| By Count of Antibiotic Administered (day of therapy) | 19 (41%) |
| By Individual Antibiotics | 16 (35%) |
| By Unit Level | 6 (13%) |
| By Service level (eg, hospitalists, surgeons) | 7 (15%) |
| By Diagnosis (eg, diagnosis code) | 3 (6%) |
| By Grams of Antibiotics Used (defined daily dose) | 12 (26%) |
| Submit to CDC’s National Healthcare Safety Network Antimicrobial Use and Resistance Module | 8 (17%) |
| Antibiotic Use Process Measures | |
| Monitor Compliance with their Antibiotic Documentation Policy | 24 (52%) |
| Monitor Adherence to Facility-Specific Treatment Recommendations | 18 (39%) |
| Outcome Measures | |
| Produce a Hospital-Specific Antibiogram | 43 (94%) |
| Unit-Specific Antibiogram | 18 (40%) |
| Antibiotic Feedback (“Reporting” CDC Core Element) | 44 (96%) |
| Distribute Antibiogram to Prescribers | 40 (87%) |
| Share Facility-Specific Reports on Antibiotic Use With Providers | 31 (67%) |
| Provide Providers Personalized Communication on Improving Antibiotic Use | 23 (50%) |
| “Education” CDC Core Element | 34 (74%) |
| Provide Education to Clinicians on Antibiotic Prescribing | 34 (74%) |
| Microbiology/Laboratory Interventionsa | |
| Review of (Any) Cultures to Ensure Optimal Antibiotic Use | 41 (89%) |
| Blood Cultures | 41 (89%) |
| Urine Cultures | 34 (74%) |
| Wound Cultures | 33 (72%) |
| Sputum Cultures | 32 (70%) |
| Microbiology Results Provide Comments to Guide Therapy | 36 (78%) |
| Microbiology Lab Uses Rapid Diagnostic Tests | 31 (67%) |
| MALDI-TOF | 17 (37%) |
| Verigene or BioFire | 9 (20%) |
| PNA FISH | 8 (17%) |
| Other | 7 (15%) |
| Review of Rapid Diagnostic Tests to Ensure Optimal Antibiotic Use | 16 (35%) |
Abbreviations: CDC, Centers for Disease Control and Prevention; MALDI-TOF, matrix-assisted laser desorption ionization time-of-flight mass spectrometry; PNA-FISH, peptide nucleic acid fluorescence in situ hybridization.
aNot specifically delineated as a “core element” in 2014 CDC Core Elements.