Sara E. Cosgrove MD, MS (is Professor of Medicine, Johns Hopkins University School of Medicine, and Director, Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore.), Roy Ahn ScM, ScD (is Vice President, Public Health, NORC at the University of Chicago.), Prashila Dullabh MD (is Vice President and Senior Fellow, Health Sciences, and Director, Health Implementation Science Center, NORC at the University of Chicago.), Janna Gordon PhD (is Research Scientist, Health Sciences, NORC at the University of Chicago.), Melissa A. Miller MD, MS (is Medical Officer, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland.), Pranita D. Tamma MD, MHS (is Associate Professor of Pediatrics, Johns Hopkins University School of Medicine. Please address correspondence to Pranita D. Tamma)
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Abstract
Background
The goal of antibiotic stewardship programs (ASPs) is to ensure that patients receive effective therapy while minimizing adverse events. To overcome barriers commonly faced in implementing successful ASPs, the Agency for Healthcare Research and Quality (AHRQ) established a multifaceted, nationwide Safety Program for Improving Antibiotic Use in 2018. This report summarizes the lessons learned from the implementation of this initiative based on structured interviews of personnel from participating sites.
Methods
At the completion of the one-year initiative, semistructured exit interviews were conducted with site leaders at 151 of the 402 hospitals that participated. These interviews consisted of open-ended questions about the perceived effectiveness of components of the Safety Program. Qualitative analyses incorporated both deductive coding themes (based on existing literature) and an iteratively developed inductive coding framework (based on salient themes that emerged from a subset of interviews).
Results
Several components of the Safety Program were identified as effective in expanding local stewardship activities, including techniques and strategies to implement sustainable ASPs, access to Implementation Advisors to keep sites engaged, provision of local benchmarked antibiotic use data to compare to similar hospitals, and Safety Program materials such as the antibiotic time-out tool to integrate stewardship techniques into daily work flows. The biggest challenges to greater effectiveness were suboptimal frontline staff engagement and difficulty changing antibiotic prescribing culture. Some approaches used to overcome these barriers (peer-to-peer communication and education through team huddles, identifying physician champions, informal rounds to enhance collegiality and buy-in, and engagement of hospital leadership) were identified.
Conclusion
Lessons learned from the Safety Program can be applied by other teams looking to promote an effective ASP at their hospital or system. The themes that emerged in this study likely also have relevance across a wide range of large-scale quality improvement initiatives.
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