Pediatric ASP Toolkit

Obtain Support from Senior Leadership

• Examples: chief medical officer, quality & safety officer, chief nursing officer, director of pharmacy
• Obtain a Leadership Commitment Letter
  • Example letters: St. Louis Children’s Hospital; Seattle Children’s
• Commit to providing: 
  • Time for program leader(s), 
  • Resources, 
  • Regular meetings with leadership to present ASP outcomes data, 
  • Appointing a senior executive leader as ASP “champion”, 
  • Regular reporting to senior leadership, 
  • Supporting enrollment in and reporting to the National Healthcare Safety Network (NHSN) Antimicrobial Use and Resistance (AUR) module including providing necessary information technology support, 
  • Ensuring staff from key support departments such as nursing, microbiology laboratory, and information technology have sufficient time to contribute to stewardship activities

Develop a Business Plan

• Example Plans:
  • Colorado Children’s Business Plan
• How to Pitch an Antibiotic Stewardship Program to the Hospital C-Suite- Brad Spellberg et al. Open Forum in Infectious Diseases 2016
• For guidance on conducting a cost assessment of phasing out purchase of meat raised without routine antibiotics, see the “Leadership Commitment” section of the Antibiotic Stewardship Through Food Animal Agriculture Module produced by CCCAS.

Develop a Hospital ASP Policy

Examples of Policies:

• Examples of Policies: St. Louis Children’s Hospital; Children’s Hospital of Philadelphia; Children’s Mercy Hospital-Kansas City; Seattle Children’s; Texas Children’s Hospital

Organizational Structure

Areas where ASPs can report (can be multiple):

• Quality and Safety 
• Infectious Diseases Division
• Infection Prevention and Control
• Pharmacy and Therapeutics Committee

ASP Team and Committee Members

Core Personnel:

• Pediatric Infectious Diseases Physician
• ID Pharmacist preferably with training in antibiotic stewardship
• Data Analyst

Other Essential Personnel

• Infection Preventionist
• Microbiologist
• Nursing Leader (see below)
• Clinicians from services impacted by the ASP (eg, Hospitalists, Surgeons, Intensivists)
• Clinical Pharmacists
• Family Advisor/Advocate
• Quality Improvement Specialists

Nursing Expertise

Nursing Leader, Advanced Practice Registered Nurse, Bedside Registered Nurse

The CDC, the Joint Commission, and the American Nurses’ Association highlight the need to engage nurses in antibiotic stewardship efforts. Nurses hold a key role in communication with patients and families regarding all aspects of care, including antibiotic use. Nurses are highly trusted by the public and provide care in the community, hospital and home care environments. Nursing engagement can thus greatly extend the reach of antibiotic stewardship efforts.

Examples of nurses’ roles/involvement in improving antibiotic use:

• Obtaining appropriate cultures with proper technique before antibiotics are started
• Improving evaluation of penicillin allergies
• Prompting discussions of antimicrobial treatment, indication and duration
• Include nurses in stewardship rounds
• Encourage nurse antibiotic stewardship champions at the unit level
• Patient education about antibiotic use
• Telephone consultation and triage of ambulatory patients with acute infectious concerns
• Reducing medication waste related to unused antibiotic doses

References for nursing expertise in antibiotic stewardship:

• Centers for Disease Control and Prevention. The Core Elements of Hospital Antibiotic Stewardship Programs: 2019. Available from https://www.cdc.gov/antibiotic-use/healthcare/pdfs/hospital-core-elements-H.pdf
• Centers for Disease Control and Prevention and The American Nurses Association. Redefining the Antibiotic Stewardship Team: Recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship Practices. Available from: https://www.cdc.gov/antibiotic-use/healthcare/pdfs/ANA-CDC-whitepaper.pdf.
• The Joint Commission. (2016). Approved: New Antimicrobial Stewardship Standard. Joint Commission Perspective. Available from: https://www.jointcommission.org/assets/1/6/New_Antimicrobial_Stewardship_Standard.pdf
• Olans RN, Olans RD, DeMaria A, Jr. The Critical Role of the Staff Nurse in Antimicrobial Stewardship–Unrecognized, but Already There. Clin Infect Dis. 2016 Jan 1;62(1):84-9.
• Edwards R, Drumright L, Kiernan M, Holmes A. Covering more Territory to Fight Resistance: Considering Nurses’ Role in Antimicrobial Stewardship. Journal of infection prevention. 2011 Jan;12(1):6-10.