Antimicrobial stewardship program

Background

Program to ensure that antimicrobials are used appropriately, in order to improve patient outcomes

Need support from senior leadership, including chief medical officer, chief nursing officer, and director of pharmacy
Need leaders to give time to manage the program, resource (including staffing)
Accountability and responsibilities
Available expertise on infection management
Education and practical training
Other actions aiming at responsible antimicrobial use
Monitoring and surveillance
Reporting and feedback

Preauthorization
Prospective audit and feedback
Didactic educational activities, including lectures and pamphlets
Facility-specific clinical practice guidelines for common syndromes
Reducing use of antibiotics with increased risk of C. difficile infection
Prescriber-led review, including antibiotics time-outs and stop orders
Computerized clinical decision-making support at the time of prescribing
PK monitoring and adjustment of aminoglycosides and vancomycin
Alternative dosing of β-lactams
Interventions to increase the use of oral antibiotics for initial therapy as well as timely transition from IV to oral antibiotics
Interventions to reduce the duration of antibiotics to shortest effective duration
Allergy assessments and penicillin skin testing for patients with reported β-lactam allergy
Development of stratified antibiograms (e.g. by location or age)
Selective and cascade reporting of antimicrobial susceptibility
Rapid viral testing for respiratory pathogens to reduce the use of inappropriate antibiotics
Rapid diagnostic testing on blood specimens
Serial procalcitonin in ICU patients