Getting in the drug stewardship 'driver's seat"

January 12th, 2015

As a key complement to its new antibiotic use tracking system, the Centers for Disease Control and Prevention is partnering with the Institute for Healthcare Improvement (IHI) in a pilot program to prevent overuse and misuse of antibiotics in hospitals.

“We know across hospitals that there are opportunities to address the overuse and misuse of antibiotics,” says Diane Jacobsen, MPH, CPHQ, director of the IHI in Cambridge, MA. “For example, limiting [therapy] to the narrowest spectrum antibiotics that are appropriate or effective would be a huge step to minimize the risk of C. diff and other antibiotic-related adverse events.” The new program uses the IHI “Driver Diagram and Change Package,” a quality improvement approach that has been used successfully in other areas.

“We see this as a critical component of our efforts to promote better use of antibiotics in hospitals and healthcare facilities,” says Arjun Srinivasan, MD, a medical epidemiologist in the CDC's Division of Healthcare Quality Promotion. “This fits hand in glove with [the CDC antibiotic-use tracking system.] We want people to implement interventions to improve use, but then we also want them to measure use so that they know if their interventions are being successful.” According to the IHI, the driver tool is designed to help organize “theories and ideas about the changes an organization can make to improve outcomes.” The IHI antibiotic program was not available for review as this was posted, but officials provided some highlights. Jointly developed by CDC and IHI with guidance and input from a variety of experts, the driver diagram lays out a number of practical steps that hospitals can follow. Ultimately, the idea is to embed the fundamental changes required for antibiotic stewardship in the system of care, especially at the points of care. “It basically works on improving systems of care,” Srinivasan says. “We looked critically at the way antibiotics are used, looked at the available information that has been published, and broke it down into components. We looked for all the different places where antibiotic use could potentially be improved.” For example, unbroken lines of communication are required to ensure therapy is “deescalated” to the narrowest appropriate spectrum, Jacobsen notes. “That is one of the areas that we are focusing on – deescalating to the antibiotic that is most appropriate once you have that culture and sensitivity information back,” she says. “But that requires a robust communication system so that the information is reported back and acted on once the cultures and sensitivities are done. Sometimes that can fall by the wayside. “

For more on this story see the January 2012 issue of Hospital Infectin Control & Prevention