1. Starting an Outpatient Antibiotic Stewardship Program

How to utilize the toolkit?

The structure of any antibiotic stewardship program should include the core elements of an outpatient antibiotic stewardship program. This toolkit has a section for each core element.

Key steps for starting an antibiotic stewardship program are listed below with links to sections within the toolkit that have more information and resources. The following should help you incorporate the core elements into your program:

1. Build the case for outpatient antimicrobial stewardship

• AAP policy statement, Antibiotic Stewardship in Pediatrics 
• CDC Core Elements of Outpatient Stewardship
• The Joint Commission AMS Standards for Ambulatory Care Centers
• The National Action Plan for Combating Antibiotic-Resistant Bacteria calls for a reduction in inappropriate antibiotic use by 50%. Refer to Antibiotic Use section.
• Antibiotic resistance is increasing in children.
• Adverse drug reactions including C. difficile are increasing.
• Economic impact of antibiotic resistance.
• Antibiotic development is lacking.

2. Commitment to Improve Use

• Identify a single leader
• Use of Commitment Poster, see examples:
  • CDC
  • Minnesota Department of Health
  • NY Health Department
• Economic incentives

3. Develop and implement at least one action for policy and practice

• Prospective Audit
• Behavior economic techniques
  • Peer Comparison
  • Accountable Justification
• Implementation of Guidelines
• Improve vaccination rates
• Use watchful waiting
• Clinical decision support

4. Tracking and Reporting

5. Education

• Development of communication skills
• Patient/Family education