Implementing a Cost-Effective Antibiotic Stewardship Program at Two Non-Teaching Community Hospitals

Background: While 8 out of 10 US hospitals belong to the non-teaching community hospitals (NTCH) category, most published studies describe antibiotic stewardship programs (ASP) established at large academic centers. We present our 4-year experience of implementing a cost-effective ASP at two NTCHs in Maryland.

Methods: Upper Chesapeake Health (UCH) comprises of two NTCHs of 203 and 103 beds each. In late 2011, the administration entrusted one Clinical Pharmacist and an Infectious Disease (ID) physician to lead a robust ASP. The following antibiotics (abx) time out policy was approved: Empiric use of Level 2 abx (Carbapenems, Echinocandins, Tigecycline, Daptomycin, Linezolid, Ganciclovir, Voriconazole, Lipid Amphotericin and other non-formulary antibiotics) required an ID consult within 24 hours. Empiric use of Level 1 abx (Piperacillin-Tazobactam and Vancomycin) was restricted to 72 hours, after which either a positive culture or an ID consult were required to continue the abx further. Every day, a pharmacist reviewed culture data of patients receiving these abx and notified the prescribing physician through a sticker placed in the chart. Fluoroquinolones, Azoles, Doxycycline, and Metronidazole were automatically switched from IV to oral per policy. Order sets were streamlined according to evidence-based guidelines.

ASP required 30 hours/week of the pharmacist’s time and 5 hours/week of the ID Physician’s time. Abx utilization [based on defined daily dose (DDD)/1000 patient days] and purchase price was measured. Periodic education and feedback were provided to physicians and leadership.   

Results:

Table showing the outcomes of clinical pharmacist’s review. Physician compliance with our ASP was >95%. Figures 2 and 3 show savings of over $1,000,000 in abx purchase over 4 years despite an upward trend in total pharmacy costs.

 

 

 

Figure 1

Figure 3

 

 

Conclusion: ASP can be successfully implemented in resource-limited, non-teaching community hospitals resulting in significant cost savings. Leadership support is critical to the success of ASP.