Antimicrobial stewardship program (ASP) advancement in Rhode Island (RI) since implementation of a statewide antimicrobial stewardship task force (RIASTF)

Background: RI is one of only a few states with a statewide pharmacy ASP task force (RIASTF). Through collaboration between all acute care institutions in the state, its mission is to lead national efforts in reducing antimicrobial-resistant hospital-associated infections.

Methods: Two 25-question self assessment surveys were developed in order to describe changes in ASP prevalence/characteristics in all acute care hospitals which may have been augmented by RIASTF’s establishment in May 2011.  A "Pre-Survey" assessed each hospital’s ASP involvement as of May 2011 and a "Post-Survey" assessed this as of February 2013. Hospital representatives who attended the RIASTF meetings completed the surveys on paper; for those not present, the survey was conducted by an investigator via telephone who then entered all answers into web-based versions of the survey.

Results: Representatives from 100% (11/11) of RI's acute care hospitals responded to the surveys: 45.5% represented community hospitals and 54.5% represented teaching hospitals. Hospitals that reported having a full ASP program increased from 18.2% in 2011 to 54.5% in 2013; those without ASP plans decreased from 36.4% to 9.1%. The same top 2 barriers to ASPs were identified in 2011 and 2013 (lack of financial resources and lack of infectious disease personnel); however, their incidence decreased from 63.6% to 45.5% and 54.5% to 36.4%, respectively. Of hospitals that reported “not a priority” (27.2%) and “not consistent with institutional philosophy” (18.2%) as barriers in 2011, 0% reported these obstacles in 2013; those reporting “no barriers” increased from 0% to 36.4% from 2011 to 2013. Hospitals with no full time equivalents (FTEs) allotted to ASP pharmacists or physicians in 2011 decreased from 72.7% to 36.4% and 90.9% to 54.5%, respectively in 2013; those allotting >0.5 FTEs increased from 18.2% to 45.5% and 0% to 27.3%, respectively.

Conclusion: Many studies describe the success of single hospital ASPs, but assessment of stewardship strategies across a larger statewide scale is limited.  Since the implementation of a statewide collaborative, there has been significant ASP advancement in RI; RIASTF may have played a role in this progress, thus supporting the adoption of similar programs in other states.