Page 1 of 1

Ø 2G RESOURCE: A Review of Antimicrobial Stewardship Interventions With Suggested Process/Monitoring, Antibiotic Use, and Additional Measures of Impact

Tools and Resources

Purpose: A tool to review types of antimicrobial stewardship interventions, comparing process measures, antibiotic metrics, and other factors to track.

Source: Developed by B. Ostrowsky and P. Chung, Montefiore Medical Center, for ERASE C. difficile Project toolkit.

Intervention Type1,2Process/MonitoringPossible Antibiotic Use Measures To Access ImpactAdditional Measures, Including Benefits/Unintended Consequence
Formulary changes, restrictions, and preauthorization
  • Number of calls/requests for restricted drug (changes over time).
  • Percentage of requests approved (over time by staff).
  • Number of formal Infectious Diseases consultations.
  • Total number of courses or patients on restricted antibiotics, alternative antibiotics to the restricted drug.
  • Defined daily doses.
  • Time to receipt of antibiotics (delays).
  • Number of doses dropped/missed.
  • Antibiotic costs.
Audit and feedback to providers
  • Number of patients who met criteria for auditing, reviewed, advice given, intervention made, and advice accepted.
  • Number of formal Infectious Diseases consultations.
  • Days of therapy for antibiotics and total patients on redundant antibiotic combinations.
  • Defined daily doses.
  • Length of stay.
  • Clinical failure—reinstitution of broad antibiotic regimens.
  • Readmissions.
  • Antibiotic costs.
Flow and algorithms for empiric and streamlined regimens for specific diagnoses or pathogens
  • Web hits for educational pages with algorithms.
  • Educational assessment of understanding of guidelines.
  • By limited chart/patient review—percentage of patients receiving/tailoring antibiotics per protocols.
  • Total number of patients with syndrome or diagnosis on appropriate antibiotics (may have external validated measure such as Centers for Medicare & Medicaid Systems [CMS] core measures, e.g., pneumonia).
  • Total number of courses or patients on antibiotics and duration of antibiotics involved in protocol.
  • Length of stay.
  • Readmissions.
Antibiotic order forms and automatic stop orders
  • Number of patients per month where antibiotic form used.
  • By limited review—percentage of patients where antibiotic order form was used, e.g., to continue or stop antibiotics.
  • Total number of patients with syndrome or diagnosis on appropriate antibiotics or for appropriate length (may have external validated measure such as CMS core measures for surgical prophylaxis).
  • Total number of courses or patients on antibiotics and duration of antibiotics involved in the automatic orders (may be by service, prescriber, patient population, or forms/order).
 
Novel approaches to use of technology and stewardship staff
  • Will depend on nature of intervention.
  • Number of calls, requests, or interventions by specific staff (percentage acceptance rates).
  • Number of patients per month/timeframe where technology used.
  • Will depend on nature of intervention.
  • Comparison of specific antibiotic courses before and after intervention.
  • Will depend on nature of intervention.
Educational component for clinicians and patients
  • Number of educational programs.
  • Number of attendees.
  • Survey of attitudes or understanding about prescribing topic.
  • Will depend on nature of education.
  • Total number of courses or patients on antibiotics and duration of antibiotics involved.
  • Improved visibility of program.
  • Collaborative care or camaraderie with other services.
  • Possible exchange of ideas about processes and choice of therapy.

1. Traditional methods such as intravenous to oral switch programs and dose optimization may be used by a well-rounded antimicrobial stewardship team, but on their own will likely not be effective interventions directed at decreasing C. difficile infection.
2. Categories adapted from Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Guidelines for Developing an Institutional Program To Enhance Antimicrobial Stewardship (PDF File; Plugin Software Help).

Instructions: Use when considering ways to monitor processes and outcomes related to targeted interventions.

Return to Question 2

Page last reviewed September 2012
Internet Citation: Ø 2G RESOURCE: A Review of Antimicrobial Stewardship Interventions With Suggested Process/Monitoring, Antibiotic Use, and Additional Measures of Impact: Tools and Resources. September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cdifftoolkit/cdiffl2tools2g.html