Antibiotic Stewardship: Correct Drug, De-escalation of therapy, Discontinuation of therapy, Correct Dose, and Diagnosis

Antibiotic stewardship was implemented in 2011 and focuses on five 'D's': Drug, De-escalation of therapy, Discontinuation of therapy, Dose and Diagnosis. The pharmacy department automatically adjusts therapy based on patient's renal function and enforces restrictions on certain antibiotics. All of the restricted antibiotics require infectious disease physician approval prior to being verified by a pharmacist. Pharmacists enter a 7-day hard stop date on all antibiotics, unless otherwise specified by the prescribing physician. The laboratory department also utilizes the Verigene BC-GP test on all blood cultures with a gram positive stain and then reports the testing results to a pharmacist. The pharmacist then notifies the physician if antibiotic therapy is needed to be streamlined or adjusted based on the microorganism. The health system reviews antibiotic usage along with C.diff rates through regular meetings of the infection control dommittee. Appropriateness of antimicrobial therapy is also reviewed during Intensive Care daily patient care rounds.

Antibiotic stewardship was implemented in 2011 and focuses on five 'D's': Drug, De-escalation of therapy, Discontinuation of therapy, Dose and Diagnosis. The pharmacy department automatically adjusts therapy based on patient's renal function and enforces restrictions on certain antibiotics. All of the restricted antibiotics require infectious disease physician approval prior to being verified by a pharmacist. Pharmacists enter a 7-day hard stop date on all antibiotics, unless otherwise specified by the prescribing physician. The laboratory department also utilizes the Verigene BC-GP test on all blood cultures with a gram positive stain and then reports the testing results to a pharmacist. The pharmacist then notifies the physician if antibiotic therapy is needed to be streamlined or adjusted based on the microorganism. The health system reviews antibiotic usage along with C.diff rates through regular meetings of the infection control dommittee. Appropriateness of antimicrobial therapy is also reviewed during Intensive Care daily patient care rounds.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

  • Safe
  • Timely
  • Effective
  • Efficient
  • Equitable
  • Patient-centered

(The Institute of Medicine's six aims for improvement.)

Related Resources

Case Studies
Public
As many older patients are affected by Clostridium difficile (C.diff) in hospital settings,
Case Studies
Public
Despite implementing universal gloving, an increased emphasis on hand hygiene and antibiotic stewardship measures, the facility ended the year with
Chairperson's File
Public
National attention to the issue of antibiotic stewardship is increasing.
Advisory
Member
Media Advisory: The Centers for Disease Control and Prevention (CDC) today issued a call to action on antibiotic stewardship.
Toolkits/Methodology
Public
The Evaluation and Research on Antimicrobial Stewardship's Effect on Clostridium difficile (ERASE C. difficile) Project
Magazine/Newspaper
Public
A recent study of 39 children's hospitals revealed 16 organizations have antimicrobial stewardship programs in place and another 15 hospitals are p