HMS Antimicrobial Use Toolkit

• The workgroup will likely be a new subgroup of your antimicrobial stewardship team.
• For maximum impact, the workgroup should consist of a multidisciplinary team that includes (but is not limited to) key stakeholders, such as a Hospitalists, Infectious Diseases physicians and/or pharmacists, Emergency Medicine physicians, house officers, IT personnel, microbiology lab representatives, and nursing.
• Designate an internal lead for urinary tract infection (UTI) and pneumonia antibiotic-related quality improvement efforts. This person is responsible for ensuring implementation of interventions recommended by the workgroup, as well as identifying barriers and troubleshooting during implementation.
• Meet quarterly to review data, define problem areas, identify underlying causes of problem areas and determine interventions for improvement.
• Communicate work to local leadership to ensure institutional buy-in.
• Engage key stakeholders in the design of interventions to encourage provider buy-in.
• When implementing interventions, consider using behavioral economic principles or social psychology to provide additional cultural incentives to change: in other words, make the right thing easier (e.g., automatic) and the wrong thing harder (e.g., removing from order sets).
• Implement at least two new interventions per year.
• Assess post-intervention data for success or failure of intervention, and make modifications as needed.

• HMS site reports (hard copy distributed at collaborative wide meetings and live reports available daily via the HMS data entry system)
• CDC Core Elements of Hospital Antibiotic Stewardship Programs
  • Video with summary of updates to the Core Elements: Click Here
• CDC’s Antibiotic Stewardship Training Courses
• IDSA Guidelines for Implementing an Antibiotic Stewardship Program
• Quality Improvement Organizations MITIGATE Antimicrobial Stewardship Toolkit: A practical guide for implementation in adult and pediatric emergency department and urgent care setting
• Society of Hospital Medicine Webinar – Rapid Clinical Updates: Antimicrobial Stewardship for Hospitalists
• Joint Commission – 2023 Antibiotic Stewardship Requirements
• Henry Ford Antimicrobial Stewardship Transition of Care Program
  • Antimicrobial Stewardship Transition of Care Gap Analysis Tool
• For HMS Members (Additional authentication may be required):
• • • Presentation by Dr. Arjun Srinivasan at the July 31, 2019 HMS Collaborative Wide Meeting: An Update on National Stewardship Activities 2019

Small Hospitals/Rural Sites:

• CDC Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals

• ANA/CDC White paper. Redefining the Antimicrobial Stewardship Team. 2017.
  • Demonstrates importance of nursing and multidisciplinary antibiotic stewardship teams, highlighting roles individuals can play in stewardship efforts
• Heil E, et al. Essential Role of Pharmacists in Antimicrobial Stewardship. Infect Control Hosp Epidemiol 2016.
  • Highlights the critical role of antimicrobial stewardship-trained pharmacists in a successful hospital stewardship program
• Saint S, et al. Importance of leadership for successful implementation of interventions to prevent hospital-acquired infections. Infect Contol Hosp Epidemiol 2010.
  • Strong leaders focused on overcoming barriers, inspired their employees, and thought strategically while acting locally
• Schoyer E, et al. Clostridioides difficile infection. AHRQ Making Healthcare Safer III 2020.
  • Demonstrates the importance of antimicrobial stewardship in the prevention of Clostridioides difficile infection, including a summary of articles published from 2008 – 2018
• Sikkens JJ, et al. Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals: The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) Participatory Intervention Study. JAMA Intern Med 2017.
  • Shared the problems of inappropriate prescribing, and allowed providers free choice to develop an intervention
  • Inappropriate antimicrobial prescribing decreased