967. The First Step is Always the Hardest: Building a Framework for Stewardship across a Large, Diverse Healthcare System
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
  • ID week poster_Building a Framework for Stewardship Across a Large Diverse Healthcare System.pdf (386.3 kB)
  • Background: Alarming trends in antibiotic resistance have sparked a National Action Plan endorsing antimicrobial stewardship programs (ASP) in healthcare facilities.  Carolinas HealthCare System provides care in 3 states and in varied settings - ranging from critical access facilities to large academic and community medical centers as shown in Figure 1. 

    Figure 1.  Regional Networks and Facilities

    ASP also vary by facility, ranging from mature programs to those taking first steps.  We sought to establish an ASP framework across 28 acute-care hospitals, utilizing varying clinical information systems, by uniting local resources with an advisory team led by a medical director, two clinical pharmacists, and a data analyst. 

    Methods:   In Fall 2015 each facility chose a pharmacist, physician, and administrative ASP champion.  Days of therapy (DOT) per 1000 patient days was adopted for monitoring select antibiotics monthly.  Baseline usage data from September 2014 – August 2015 was collected.  A gap analysis survey of CDC Core ASP Elements was conducted to stratify facilities into 3 tier-levels (1,2, and 3) with 1 having the most comprehensive ASP.  Target and stretch DOT reduction goals were set for each facility.  Site visits were conducted in winter 2016, 3 – 4 major goals set, and a post-visit summary provided.  Pharmacists set up monthly facility meetings to assess progression, and a bi-monthly virtual meeting for sharing best practices.  Curriculum for an ASP symposium was developed based on global educational needs.

    Results:  Data (DOT/1000 patient days) on 17 selected antibiotics were collected in 28 acute-care hospitals for each month between September 2014 and present.  Reduction goals by tier are shown in table 1. 

    Table 1. Goal Reductions in DOT/1000 Patient Days by Tier

    Tier Level

    Number of Facilities
    or Regional Networks
    (n = 28 facilities)

    Goal – Stretch Reduction (%)



    5 – 10


    2.5 – 5



    2.5 – 5


    1 – 2.5



    1 – 2.5

    * = 12 facilities; ** = 5 facilities

    Goal progression by tier is shown in Figure 2, with some early, modest decline in use metrics.


    Figure 2.  Goal Progression by Tier

    Conclusion:  Building a unified ASP framework across a diverse system presents many challenges, but appears feasible based on our early work.  More work is needed to establish a national ASP benchmark.

    Julie E. Williamson, PharmD1, Andrea Y. Logan, PharmD1, Emily K. Reinke, PhD2, Steven Jarrett, PharmD1, Cynthia Clarke, RPh1 and Lisa E. Davidson, MD3, (1)Quality and Patient Safety, Carolinas HealthCare System, Charlotte, NC, (2)Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, NC, (3)Department of Medicine, Carolinas Medical Center, Charlotte, NC


    J. E. Williamson, None

    A. Y. Logan, None

    E. K. Reinke, None

    S. Jarrett, None

    C. Clarke, None

    L. E. Davidson, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.