Antimicrobial Stewardship Program Guidance

Hospital leadership commitment: dedicate human, financial, and technological resources

While an antimicrobial stewardship program pharmacist often leads the charge, success depends on active participation from various teams, including medical staff, nursing, infection prevention, microbiology, IT, environmental services, supply chain and more.

Engaging stakeholders by addressing their specific challenges, such as reducing resistance rates or improving diagnostic turnaround times, fosters collaboration.

Pharmacists play a pivotal role in advocating for AMS resources, leveraging regulatory requirements and financial data to build a compelling business case. By projecting cost savings from AMS interventions, pharmacists can demonstrate a strong return on investment to hospital leadership.

Accountability: Appoint a leader(s) for program management and outcomes

The Joint Commission MM.09.01.01 elements of performance 14 requires that the hospital coordinate its antimicrobial stewardship program with pharmacy, infection prevention and control, quality and performance improvement, medical staff, and nursing services.

Consider topics including antimicrobial use, antimicrobial resistance, adherence to AMS policies and interventions, supply chain updates, treatment guideline updates, new research, diagnostic updates, regulatory updates, and performance improvements as standing discussion items.

• Define roles, goals, and metrics for your AMS program: Create a formal policy outlining leadership roles, goals, AMS activities, success metrics, and competency-based training and education.
• Antibiotic stewardship program leadership: A leader or co-leaders, preferably a physician and/or pharmacist with infectious disease training, provides an invaluable communication link and source of credibility with medical staff.
• Program goals aligned to core elements of antimicrobial stewardship: Set priorities to optimize antimicrobial use, prevent resistance, and reduce unnecessary usage. Focus on areas such as antibiogram trends, high SAAR, and hospital-acquired infections.
• AMS program activities and key metrics: Design system-level interventions (e.g., antimicrobial restrictions, diagnostic testing) and patient-level activities (e.g., real-time feedback on prescriptions) to achieve program goals. Document interventions and track metrics like days of therapy and susceptibility trends to evaluate outcomes.
• AMS program education: Provide competency-based training on antimicrobial stewardship during staff orientation and annually, ensuring documentation for accreditation. Leverage existing infection prevention training resources, such as those from the WHO, CDC, and IDSA, to develop educational materials.

Pharmacy expertise: Appoint a pharmacist to lead efforts to improve antibiotic use

Pharmacists bring essential drug expertise and, when trained in infectious diseases, can significantly enhance patient care and reduce healthcare costs. As co-leaders of stewardship programs, they play a pivotal role in applying evidence-based guidelines to optimize prescribing practices and ensure standardized, equitable care across healthcare systems.

Address the 2023 Joint Commission AMS standards EP 18 and EP 19 by implementing evidence-based guidelines for common antibiotic indications and assessing adherence to evidence-based guidelines. Explore best practices and actionable strategies for selecting, implementing, and assessing adherence in Using evidence-based guidelines to improve prescribing.

Action: Implement interventions to improve antibiotic use

Understanding the intent of prescribing an antimicrobial is essential for pharmacists to provide prospective feedback and analyze prescribing patterns at an aggregate level. Preauthorization, prospective audit and feedback, and facility-specific treatment recommendations should be your first priorities when implementing interventions, then consider the below:

• Infection-based interventions: improving diagnostic testing, reviewing microbiology results, and adjusting therapies.
• Provider-based interventions: antibiotic timeouts at 48 hours and allergy assessments.
• Pharmacy-based interventions: IV to PO conversion, dose optimization, documentation of indications, and duplicative therapy alerts.
• Microbiology-based interventions: susceptibility reporting and result interpretation for clinicians.
• Nursing-based interventions: education on proper techniques in obtaining specimens to reduce contamination.

Data analytics and machine learning can analyze vast data and provide real-time alerts as patterns emerge. Sentri7’s Antimicrobial Stewardship dashboard detects anomalies in antimicrobial prescribing (measured by Days of Therapy) and notifies AMS leaders of potential issues. AMS leaders can then investigate antimicrobial use and microbiology results to decide on prescribing restrictions or infection control measures to prevent drug-resistant organism spread.

Tracking: Monitor prescribing, intervention impacts, and other key outcomes with AMS technology solutions

Continuous improvement and ongoing funding depend on documenting and communicating results to both hospital administrators and prescribers. Antibiotic usage should be tracked closely to determine the impact of AMS interventions. Sending usage data electronically to the National Healthcare Safety Network enables hospitals to benchmark their own performance using the Standardized Antimicrobial Administration Ratio (SAAR). Other outcomes to consider may include C. difficile infection, resistance patterns, and financial metrics. Tracking and reporting on compliance with documentation policies is also important. Hospitals then often add reporting on adherence to facility-specific treatment recommendations and pharmacy interventions by unit and prescriber, with feedback to all clinicians.

ONC-certified technology, like Sentri7 Pharmacy, is a required component to meet regulatory requirements. In 2024, the Medicare Promoting Interoperability program added new requirements for the reporting of Antimicrobial Use (AU) and Antimicrobial Resistance (AR) data to the National Healthcare Safety Network (NHSN). Some metrics, such as Days Present and AR event inclusion, are complex and challenging to tabulate; NHSN would not accept manual submission.

Reporting: Antibiotic use and resistance reporting identify opportunities for improvement

Share information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership. Data helps leaders identify specific targets in their processes and performance improvement efforts, enabling them to measure impact and determine whether the interventions are achieving the desired outcomes.

AMS programs should operate transparently to ensure continual commitment from all stakeholders. Process and outcome measures should be shared regularly with prescribers, pharmacists, nurses, and leadership.

AUR reporting

Antimicrobial Use and Resistance (AUR) reporting is essential for combating antimicrobial resistance and improving hospital practices. By submitting AUR data to the National Healthcare Safety Network (NHSN), hospitals enable the CDC to benchmark antimicrobial use, track resistance patterns, and identify emerging threats. This data helps institutions optimize antibiotic prescribing, uncover areas of overuse or underuse, and develop targeted interventions. Additionally, AUR reporting supports compliance with CMS’s Promoting Interoperability Program, which ties reporting to financial incentives and accreditation.

Education: Inform on adverse reactions, antibiotic resistance, and optimal prescribing

Clinicians and staff need to understand why antimicrobial stewardship matters, how the hospital plans to improve its stewardship, and how they can contribute to this effort. Case-based education in the setting of prospective audit or preauthorization can be particularly timely and effective with prescribers.

Roles of the ASP pharmacist include the development and maintenance of clinical guidelines, dose optimization, prescriber education and approval of restricted anti-infectives.

Examples of AMS education include

• Developing new treatment guidelines in concert with changes in the literature
• Sharing updates to therapy recommendations with pharmacists and physicians
• Including attestations and informational links within prescribers ordering of experimental agents
• Implementing prescriber ordering restrictions as needed to change with practice