The Georgia Healthcare Associated Infections Advisory Committee, representing a broad partnership of stakeholders in the state, invites you to engage in antibiotic stewardship and to be recognized for your efforts publicly.
Facilities that apply will be recognized by this state partnership for their commitment, listed on an Honor Roll web site, and receive a certificate of recognition. In addition, the state partnership will provide resources and technical support to assist facilities in engaging in antibiotic stewardship.
There are three requirements for Phase I of this project: (1) Letter of Commitment from Leadership, (2) Identification of an Antibiotic Stewardship Team, and (3) an Educational Event. A second phase (Implementation) is also available for those healthcare facilities which have completed Phase I.
Phase I: Engagement
Item 1: Letter of Commitment from Leadership to Georgia Antibiotic Stewardship Subcommittee
- A statement of commitment of the facility to engage in antibiotic stewardship
- An educational event (see Item 3)
- Request to report progress back to the facility executive board in one year
- Signature of CEO/CMO and board member
- Sample letter to Georgia HAI Advisory Committee
Item 2: Identification of Antibiotic Stewardship Team
- List at least four members of your antibiotic stewardship team and their roles
- The stewardship team needs to include a physician champion and a clinical pharmacist. The remaining members of your team will depend upon your facility personnel and resources. Members may include physicians, pharmacists, infection preventionists, patient advocates, administrators, information technology, quality, etc. Stewardship efforts benefit greatly from infectious disease expertise. The physician champion and a clinical pharmacist, however, do not need to have advanced training in infectious diseases to lead the facilities efforts to improve antibiotic prescribing.
- Team must meet at least quarterly during a 12 month period
- A role of the team is to plan a staff educational event on antibiotic stewardship; additional activities may be conducted as well
Item 3: Educational Event
- Conduct at least one staff educational event during a 12-month period. The educational event must be summarized in the executive letter (see Item 1).
- The purpose of the educational event is to inform facility staff regarding the need for antibiotic stewardship and practices. The educational event should identify a target audience at the facility for the training (e.g., hospitalists, pharmacists, physicians, physician assistants, etc.).
- Sample educational events include:
- Conducting an in-service on core concepts of antibiotic use
- Instructing staff on educating patients on antibiotic stewardship efforts at your facility
- Integrating/updating antibiotic stewardship practice into medical school curriculum
- Integrating antibiotic stewardship training in new employee orientation
Phase II: Implementation
All hospitals that meet Phase I will be included on the honor roll and receive a certificate. We recognize there may be a few hospitals that are implementing and measuring antibiotic stewardship activities and completing the requirements below. For those hospitals that meet these requirements, they are welcome to apply for Phase II (implementation). For those that meet the Phase II requirements, a symbol will be added next to their facility name to indicate these additional activities.
Item 4: Antibiotic Stewardship Programs
- Facility must demonstrate that it is actively engaged in antibiotic stewardship activities that are outside of evaluating formulary and pharmacy costs
- Facility must demonstrate that it has undergone a process to select appropriate stewardship activities according to its needs and resources. This process may be a gap analysis, part of a risk assessment, or other evaluation conducted by antibiotic stewardship team. Evidence of these activities includes submission of gap analysis or risk assessment worksheet or antibiotic stewardship team meeting minutes documenting this evaluation
- Sample activities include:
- Defined formulary of antimicrobial agents and prescribing restricted to those agents on formulary
- Hospital requires pre-authorization or approval of selected antimicrobials by infectious disease physician, pharmacist, or other staff member
- Review or audit of selected antimicrobials on a daily or weekly basis by infectious disease physician, pharmacist, or other hospital staff member
- Results of audits/reviews of antimicrobial use are provided directly to prescribers, through in-person, telephone, or electronic communications
- Automatic stop orders (e.g., after 2-3 days, subject to documentation of the need for ongoing therapy) are in place for selected antimicrobials
- Prospective clinical audit and prescriber feedback, using a tool similar to that provided in the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI; see resources)
Item 5: Measurement of Antibiotic Stewardship Program
- Facility demonstrates that it is measuring the impact of antibiotic stewardship activities noted under Item 4.
- The measurement activities must be directly related to the antimicrobial stewardship activity and not a measure that is collected for another purpose and may be tangentially related to stewardship (e.g., the measurement of Lab ID Clostridium difficile infection (CDI) is required for most hospitals by CMS. By itself, Lab ID CDI is not a measurement of an antibiotic stewardship program)
- Sample measurement activities include:
- Antimicrobial consumption hospital wide or per unit.
- Plan-Do-Check-Act (PDSA) cycles for selected record reviews for antibiotic use improvement projects:
- Patients where cultures are reviewed before first antibiotic dose.
- Patients where antibiotic start date is documented.
- Patients with a documented antibiotic stop date
- Measurement activities may include the use of existing information systems, such as a laboratory data mining system that provides information regarding IV and PO utilization rates and usage of selected agents.
- Measurement of consumption as defined daily dose, using WHO methodology http://www.whocc.no/ddd/definition_and_general_considera/.
- Use of the NHSN Antimicrobial Use and Resistance Module http://www.cdc.gov/nhsn/acute-care-hospital/aur/.