Starting an Inpatient Antibiotic Stewardship Program

How to Utilize the Toolkit?

Key steps for starting an inpatient antibiotic stewardship program are listed below. Next to each step is the link to a section within the toolkit with more information and resources.

A goal for any antibiotic stewardship program is to meet all seven of the CDC core elements of an antibiotic stewardship program. The following steps should help you achieve that goal. The toolkit has a section for each core element.

Build the Case for Antibiotic Stewardship

• The Joint Commission and Leapfrog Requirements
• The National Action Plan for Combating Antibiotic-Resistant Bacteria calls for all acute care hospitals to have an ASP
• If you work in California or Missouri, your state requires antibiotic stewardship
• Antibiotic resistance is increasing in children
• Adverse drug reactions and other complications of antibiotic use, including C. difficile infection, are increasing
• Economic impact of antibiotic resistance
• Center for Medicare & Medicaid Services Condition of Participation

Obtain Leadership Commitment Letter

• Example from St. Louis Children’s Hospital

Develop a Business Plan

• Example business plan from Colorado Children’s

Develop an ASP Policy

• Examples from St. Louis Children’s and Children’s Mercy-Kansas City

Form Your ASP Team

• Determine Who Your ASP Should Report to
• Physician Leader – preferably an infectious diseases physician
  • Training opportunities and resources
  • Job description
  • Full time equivalents typically provided
• Pharmacy/Drug Expert Leader – preferably trained in infectious diseases or antibiotic stewardship
  • Training opportunities and resources
  • Job description
  • Full time equivalents typically provided

Determine the Type of Stewardship ACTIONS You Will Perform

• Prospective audit with feedback
• Prior approval (Preauthorization requirements, or ‘protected antibiotics’’’)
• Clinical practice guidelines
  • Examples including publicly available guidelines are listed
• Use of rapid diagnostics

Develop an Education Plan:

• Introduce and describe your antibiotic stewardship plan
• Educate the entire hospital staff on antibiotic resistance and stewardship

Determine Data Targets and How You Will Track Them

• Process measures include days of therapy, length of therapy, and standardized antimicrobial administration ratio
• Outcome measures include length of stay, hospital-onset C. difficile rates, antibiotic resistance

Determine How and To Whom You Will Report the Data

• Present to leadership, pharmacy and therapeutics, frontline providers
• Data presentation software
• Third party vendors
• CDC/NHSN Antibiotic Use and Resistance (AUR) modules