Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship

Ø 1M RESOURCE: Potential barriers to implementing an ASP

Purpose: In the current fiscally tight climate, your facility may be considering a number of programmatic options, all of which may be competing for the same limited resources. The following information was collected on visits to several project nonintervention sites and describes potential barriers to implementing an ASP, as well as what is needed to implement an ASP.

Source: ERASE C. difficile Project team.

Instructions: Review document to identify if a barrier exists and if resolution available.

Potential Barriers to Implementing an ASP

Category Barrier What You May Need To Implement an ASP
Organizational Issues
  • Insufficient understanding of the scope of the problems/lack of sufficient training and education.
  • Potential for savings realized from ASP to return to hospital's general operating fund rather than enhancing ASP services and overall programming.
  • Expanded education and training for staff at all levels and in all services.
  • Administrative approval to direct savings realized from ASP to staff dedicated to enhancing ASP (rather than these additional funds going back to hospital general fund).
Resources and Staffing
  • Insufficient staffing (information technology [IT], pharmacy, infectious diseases [ID]); lack of dedicated staff and capabilities.
  • Potential to compromise clinical care without dedicated staffing.
  • Lack of ID/administrative champion onsite.
  • Ability (via administrative support) to convert demonstrated savings into additional dedicated staff (assigned PharmD).
  • Outreach and training to make interdisciplinary cooperation seamless.
  • Dedicated IT/pharmacy/ID staff.
  • Ability to maintain clinical services without additional staff dedicated to ASP activities in IT, ID, and pharmacy.
Data Systems
  • Insufficient baseline and ongoing data collection or review.
  • Need for system to alert ID pharmacists of target patients.
  • Medical record system either not fully electronic or not fully integrated.
  • Ability to formally track outcomes.
  • System in place to alert ID pharmacists of target patients.
  • Improved data collection and review system.
  • Improved medical records system (conversion to electronic or fully integrated system).
  • Enhanced reporting capabilities of pharmacy.
Prescriber Culture
  • Issue of private ID physicians doing hospital consults.
  • Issue of house staff taking clinical directives from pharmacy; current prescribing culture.
  • Issue of private ID physicians assisting with surveillance.
  • Issue of hospitalists not taking responsibility for decisionmaking on rounding.
  • Training in proper use of antibiogram.
  • Training to encourage collaboration of infection prevention and pharmacy services.
  • Training of hospitalists.
Institutional Demographics
  • Smaller facilities that lack onsite full-time ID physicians and full-time dedicated staff.
  • Larger facilities whose staffing to bed size ratios only allow limited review of antibiotic prescribing.
  • Facilities with different economic constraints and many other competing priorities.
  • Ways to tailor activities and interventions to your needs, size, resources, patient and prescriber populations, and staffing.
  • Among smaller facilities, an option for stewardship activities a few times per week (audit and feedback with contracted ID staff).

Return to Question 1

Page last reviewed September 2012
Page originally created September 2012
Internet Citation: Ø 1M RESOURCE: Potential barriers to implementing an ASP. Content last reviewed September 2012. Agency for Healthcare Research and Quality, Rockville, MD.