Interdisciplinary Teamwork Yields Improved Antibiotic Stewardship

A hospital engaged in a quality improvement program launched by ASHP (American Society of Health-System Pharmacists) has identified weaknesses in existing antibiotic stewardship initiatives and implemented workflow changes that resulted in faster antibiotic administration. St. Francis Hospital in Federal Way, Wash., was recently featured in ASHP’s InterSections, which highlights the hospital’s team approach to improving infection treatment with IV antibiotics.

Antibiotic stewardship is a nationwide healthcare priority, and hospitals are working to reduce antibiotic resistance and improve appropriate prescribing. Launched in 2013, the ASHP Mentored Quality Improvement Impact Programs (MQIIP) is designed to accelerate the success of antibiotic stewardship programs (ASPs). MQIIP includes personalized mentoring by a team of pharmacist-physician experts to evaluate a hospital’s ASP and provide feedback for improvement. Six healthcare organizations have participated in the MQIIP.

According to MQIIP mentor Debra Goff, Pharm.D., FCCP, associate professor in the College of Pharmacy at Ohio State University Wexner Medical Center, program participants that demonstrated the most improvement in antibiotic stewardship had “the support and engagement of hospital administration, passionate physician-pharmacist team leaders who believed they could make a difference, and interdisciplinary team members who were open-minded and willing to be mentored.”

Serena Von Ruden, Pharm.D., RN, clinical pharmacist at St. Francis Hospital, a 134-bed nonprofit community hospital, began working with MQIIP mentors in May 2014. At that time, it took 15 minutes to 11 hours to administer the first dose of IV antibiotics after orders had been placed.

With the help of MQIIP mentors Goff and George Karam, MD, Dr. Von Ruden and her colleagues identified several causes of the problem of delayed first-dose IV antibiotic administration and developed a list of solutions.

“The process changes that we implemented really required a paradigm shift for all of us, in that all providers and pharmacists had to consider and treat first doses of IV antibiotics as STAT orders,” said Von Ruden.

After the recommendations from the mentorship were implemented, the proportion of patients who received antibiotics in a timely manner - defined as within one hour of order entry for sepsis patients and within 2 hours for nonseptic patients - rose from approximately 67% to 83%. In the ICU, the percentage of patients who received antibiotics in a timely manner rose from 62 percent to 91 percent.

Source: ASHP (American Society of Health-System Pharmacists)