S1. Antimicrobial Stewardship program development and implementation

Oral Abstract Submission

1881 - The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use: Results from a National Antibiotic Stewardship Intervention of 402 United States (US) Hospitals

Presenting Author(s)

• 

  Pranita Tamma, MD, MHS

  Associate Professor
  Johns Hopkins
  Baltimore, Maryland

  Disclosure: Nothing to disclose

Co-Author(s)

• MM

  Melissa A. Miller, MD, MS

  Physician
  Agency for Healthcare Research and Quality
  Rockville, Maryland

  Disclosure: Nothing to disclose
• PD

  Prashila Dullabh, MD

  Director
  NORC
  Bethesda, MD

  Disclosure: Nothing to disclose
• RA

  Roy Ahn, MPH, ScD

  Vice President, Public Health
  NORC
  Chicago, Illinois

  Disclosure: Nothing to disclose
• KS

  Kathleen Speck, MPH

  Research Project Administrator
  Johns Hopkins
  Baltimore, Maryland

  Disclosure: Nothing to disclose
• YG

  Yue Gao, MPH

  Sr Research Scientist
  NORC
  Bethesda, Maryland

  Disclosure: Nothing to disclose
• 

  Sara E. Cosgrove, MD, MS

  Professor of Medicine
  Johns Hopkins
  Baltimore, Maryland

  Disclosure: Basilea: Consultant
  Theravance: Consultant

Background : The AHRQ Safety Program for Improving Antibiotic Use aims to improve antibiotic (abx) use in acute, long-term, and outpatient care settings by enhancing abx stewardship programs (ASP) and engaging frontline providers to incorporate stewardship into daily abx decision making, with an emphasis on viewing appropriate prescribing as a patient safety issue. We report on the impact of implementation of the Acute Care Safety Program on abx use and Clostridioides difficile in a cohort of US hospitals.

Methods :

Methods: The Acute Care Safety Program was implemented from 12/2017-11/2018. At least one unit from each hospital participated. The Safety Program trained local ASP leaders and assisted ASPs and frontline staff to: (a) address attitudes and culture that pose challenges to judicious abx use and (b) incorporate best practices for the management of common infections into daily practice using the Four Moments of Antibiotic Decision Making framework (Figure 1). Education occurred via 17 live Webinars and an online toolkit that included recorded Webinars, narrated presentations, and other tools to assist with the development and dissemination of syndrome-specific local guidelines (Table 1). Units submitted days of abx therapy (DOT) per 1,000 patient-days (PD), C. difficile LabID events per 10,000 PD, and 10 review forms per month documenting structured discussions between the ASP and frontline staff about patients on abx. Linear and generalized linear mixed effects models were employed to calculate pre-post intervention changes in abx use and C. difficile LabID events, respectively.  

Results : 402 hospitals completed the Safety Program, including 28 (7%) academic medical centers (AMC), 289 (72%) community hospitals, and 85 (21%) critical access hospitals. 476 participating units consisted of 165 (35%) ICUs, 300 (63%) medical-surgical floors, and 11 (2%) other units. Both abx use and C. difficile LabID events decreased when comparing pre-post data (-41 DOT per 1,000 PD, [from 886.56, Figure 2], p=0.001 and -1.2 LabID events per 10,000 PD [from 6.3], p=0.027), respectively. 

Conclusion : By targeting both improving abx prescribing culture and knowledge of best practices, the AHRQ Safety Program led to reductions in abx use across a diverse cohort of hospitals.