Establishing an Antimicrobial Stewardship Collaborative Across a Large, Diverse Health Care System

Alarming trends in antibiotic resistance sparked a National Action Plan endorsing antimicrobial stewardship programs (ASPs) in health care facilities. Atrium Health consists of 28 acute care facilities with varying levels of ASP maturity. The organization sought to establish an ASP collaborative across a diverse network by uniting local resources with a central advisory team.

In fall 2015 each facility chose a pharmacist, a physician, and an administrative ASP champion. Broad-spectrum antibiotic use was tracked monthly using days of therapy (DOT) per 1,000 patient-days as a standard metric. A gap analysis survey of Centers for Disease Control and Prevention (CDC) core elements for ASPs was conducted to stratify facilities into one of three tiers, with Tier 1 having the most comprehensive ASP. Baseline antibiotic usage data were collected, and DOT reduction goals were set for each facility. Site visits were conducted in winter 2016, and a post-visit summary outlining major goals was provided. Pharmacists held monthly facility meetings to assess progress and a bimonthly virtual meeting for sharing best practices networkwide. In addition, curriculum for an ASP symposium was developed based on identified educational needs.

Almost all hospitals (25/28) fully implemented the CDC core elements for ASPs within the first year of establishing the systemwide collaborative. Most facilities (78.6%) achieved their DOT reduction goal ranging from 1%-2.5% to 5%-10%.

Despite many challenges, building a unified ASP collaborative across a diverse system enabled many hospitals to adopt best practices and improve antimicrobial use.