Antibiotic resistance is a global issue threatening to render our tried and true antibiotics useless and turn previously curable bacterial infections deadly. Per CDC data, drug-resistant bacteria already cause 2 million illnesses and 23,000 deaths each year.
Antibiotic stewardship can help combat the growth of antibiotic resistance, according to the CDC, and accreditation organizations like The Joint Commission now require hospitals to have a stewardship program in place.
Because of this, some hospital officials have made fighting antibiotic resistance a priority; however, others are still struggling to do so.
This content is sponsored by bioMerieux
A group of clinicians, hospital administrators and pharmacists gathered during the Becker's Hospital Review 8th Annual Meeting in Chicago April 18 to discuss how their facilities approached antibiotic stewardship and if rapid diagnostic tools or other technology could aid in their efforts. The discussion was led by bioMerieux, a diagnostic company.
The CNO of an Arkansas-based health system said antibiotic resistance and stewardship is "one of the most important things [the system] is dealing with." Another executive, a director of pharmacy at a system in Illinois, echoed that sentiment, labeling antibiotic stewardship as a "high priority" goal for this fiscal year, while others placed it on par with the efforts targeting any healthcare-acquired condition and said their organizations had resources dedicated to it.
However, not everyone in the nearly 30-person group felt their facilities' prioritize antibiotic resistance and stewardship. Many felt their facility wasn't concerned with antibiotic resistance because they hadn't yet had a superbug problem. Others were struggling to get the C-suite to pay attention.
"We've been challenged to put it on the agenda," said a nursing director of an independent pediatric hospital.
Challenges
For those who are trying to raise their facility's awareness about antibiotic resistance and be proactive, they face several challenges. Some of those are detailed below.
Budget and backing. Sometimes, executives in the hospital C-suite see the problem, but believe it's a pharmacy-only issue, and therefore any tools should come out of the pharmacy budget.
To overcome that issue, clinicians and pharmacists should paint antibiotic resistance as part of a larger quality improvement project, one leader said. "Quality becomes the fabric weaving [everything] together," the vice president and chief quality officer at an Indiana-based system explained, since antimicrobial resistance ties into length of stay, hospital-acquired conditions and readmissions. In other words, leaders have been breaking down barriers between departments to gain traction in antibiotic stewardship.
"A robust program can't exist in a siloed nature," said a senior vice president of pharmacy services at a multistate system in the South. He said he works closely with the system's chief quality officer to get resources devoted to the cause.
Spreading efforts to community partners. Even if a hospital has its own robust stewardship program, it can be rendered useless if other patient care organizations, like nursing homes or physician offices, aren't also participating. Some hospitals have gotten around this issue by developing strong relationships with skilled nursing homes and other facilities to share data with, but that presents its own set of challenges.
Getting effective data and technology. Getting data to make timely decisions on stewardship has been a "very difficult problem," one leader said. Getting every player — even affiliated physicians and post-acute care partners — integrated onto one IT system is a slow and expensive process. "Everyone has a different data source, we never have the same numbers," said an Illinois system's vice president of quality, care management and population health. "We have to be very clear about what data we're displaying."
Despite that, leaders are interested in IT solutions for stewardship if they are effective. In fact, pharmacists, hospital administrators and clinicians have some requirements for vendors looking to do so. According to the president of hospital medicine of an integrated system in Wisconsin, technology must do two things for it to be useful in this space: Save time for the people who interface with it and be proven to improve patient outcomes and save money. "Once you have all those factors, it sells itself," she said. For instance, a technology may look great, but if it adds work for infectious disease physicians and pharmacists, they're "not going to be that enthused about it" and won't use it.
Finding a vendor partner. Beyond finding the right technology, hospital officials are also looking for a more robust partnership, rather than simply having a vendor implement technology and leave.
"Improvement is expensive," said a surgeon from an independent hospital in Wyoming. "Vendors see hospitals as a cash cow rather than a partner for mutual survival."
Instead, hospitals are looking for a vendor that is invested in the hospital's success. Several leaders agreed a risk sharing option would be most attractive in this space, as it pulls the vendor in to be financially responsible for the success of the product once it's implemented.