Antibiotics save lives, but with each use they can cause side effects and lead to antibiotic resistance, according to the Centers for Disease Control and Prevention (CDC). The need to reduce unnecessary antibiotic use to benefit future patients has been known for some time, and the official movement continues to make progress nationally. Hospital-based antibiotic stewardship programs dedicated to improving antibiotic use can both optimize the treatment of infections and reduce adverse events, and the CDC recommends that all acute care hospitals implement a stewardship program.

Quality Insights, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Delaware, Louisiana, New Jersey, Pennsylvania and West Virginia, learned that implementing programs in health care settings to reduce the threat of antibiotic resistance was not “one size fits all.” Antibiotic stewardship programs were already in place at many hospitals throughout the QIN-QIO’s region, but there was minimal organization or standards for outpatient facilities. Quality Insights used the CDC’s Core Elements of Outpatient Antibiotic Stewardship to provide a consistent framework, actions, evidence-based practices, and standards for outpatient facilities and clinicians.

“Once I learned the what and why of antibiotic stewardship, it became apparent that we are running out of time to make these changes.”

The QIN-QIO found that while tracking and reporting results worked well in physician offices, emergency departments and urgent care centers, this was not the case for community pharmacies. Interventions were identified to improve tracking and reporting for community pharmacists by collaborating with other QIN-QIOs and the QIN National Coordinating Center (NCC).

Quality Insights also formed a Multidisciplinary Advisory Group consisting of clinicians and other health care professionals from five states to be champions of antibiotic stewardship. They spoke at education events and were highlighted in newsletters distributed to providers. Their experience was key to getting others to buy in.

“Once I learned the what and why of antibiotic stewardship, it became apparent that we are running out of time to make these changes,” said Dr. Hal P. Kramer, lead physician at Christiana Care Health System’s Medical Aid Units, and one of Quality Insight’s antibiotic stewardship champions. “I’ve been practicing medicine for over 36 years, and I too had succumbed to the lure and ease of prescribing antibiotics as they were developed and promoted.”

By July 31, 2017, the QIN-QIO recruited 1,071 facilities, mostly consisting of physician practices, but also several emergency departments, urgent care clinics and pharmacies. The work of educating/implementing the core elements was completed starting in 2017 and continued intensely through 2018. The QIN-QIO currently has 97.9 percent of targeted facilities implementing the CDC’s core elements. While this number alone is significant, consider that Quality Insights’ antibiotic stewardship work impacts thousands of clinicians and patients, and the consistent message of safe antibiotic use and the QIN-QIO’s resources reach well beyond those facilities.

Kramer said positive change has been realized at his health system, and efforts to reduce antibiotic use have been noticed by patients as well. “A highpoint in our work was when a patient came in a few months ago saying, ‘I know you all don’t give out antibiotics, but I’m really sick,” Kramer said. “Indeed, he was—with pneumonia.”