Leadership commitment underpins the success of every antimicrobial stewardship program (ASP).
Because ASPs involve many departments and key personnel within a hospital, they require commitment and best perform with active engagement of senior hospital executives. Hospital leadership can ensure the program has sufficient budget, technology, time, authority and resources to succeed.1
If antimicrobial stewardship has not been a priority of your hospital, you may want to find an executive who can advocate for you with other leaders and serve as an antimicrobial stewardship (AMS) champion in the executive suite. A receptive executive may be convinced to support the program by the abundance of evidence of cost savings from higher quality care and more careful drug selection, as well as increased patient safety and improved results of publicly reported healthcare-associated infections. A persuasive executive may secure leadership commitment from other members of the hospital's senior management, further advancing the program's acceptance and likelihood of success.
The executive advocate may continue to be involved with the antimicrobial stewardship program after its launch, particularly in areas such as setting appropriate goals, prioritizing policies and monitoring program results. This leader may also facilitate connections between the efforts of the AMS team and other quality and safety campaigns, such as those addressing community-acquired pneumonia, antimicrobial prophylaxis for surgery, or asymptomatic bacteriuria.2
A high performing antimicrobial stewardship program also needs day-to-day leadership commitment from a physician, typically an infectious disease specialist, although hospitalists assume the responsibility in some hospitals. The physician leader communicates the program's goals effectively to medical staff and department managers and has the standing to discuss prescribing habits with other senior physicians. If the physician in charge is not on the hospital staff, specific compensation for leadership of the AMS team provides necessary incentive to forgo fees from patient care and devote time to stewardship initiatives. Launching an AMS program requires quite a bit of time upfront and consistent efforts to maintain, so the physician leader must be willing to take on the responsibility and set aside the time needed to make the program successful.
Often program leadership is shared by an infectious disease physician and a clinical pharmacist. Ideally the pharmacist has a background in infectious diseases, but many senior clinical pharmacists ably fill this role in hospitals without specialized training.3 The pharmacist provides necessary expertise in best prescribing practices and provides valuable input on drug, dosing and duration guidelines that are often at the heart of stewardship programs. The pharmacist leader should also receive financial compensation for accepting the responsibilities of antimicrobial stewardship in the hospital and time away from other duties to devote to the program.
1 CDC. Core Elements of Hospital Antibiotic Stewardship Program. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
2 Doron S, Davidson LE. Antimicrobial Stewardship. Mayo Clin Proc. Nove 2011;86(11):1113-1123.
3 American Society of Health-System Pharmacists. A Hospital Pharmacist's Guide to Antimicrobial Stewardship Programs.