The University of Texas Medical Branch’s Antimicrobial Stewardship Program has been designated as a Center of Excellence by the Infectious Diseases Society of America.
The IDSA’s Center of Excellence designation recognizes institutions that display excellence in their antimicrobial stewardship practices. Institutions must meet the following criteria to be considered for this designation:
- Effective leadership for the program
- Stewardship practices consistent with national guidelines
- Protocols and policies that optimize antimicrobial usage
- Effective process for quality improvement and for implementing initiatives, tracking the impact of the initiatives and adjusting as needed
- Education opportunities for health system staff
“This accomplishment proves that the ASP is dedicated to providing the best care to our community,” ASP Clinical Director Dr. David Reynoso said. “It signals that the sacrifices and time spent building relationships within the UTMB health system, providing prospective feedback to our colleagues and changing the culture of antimicrobial stewardship at the grassroots provider level has been worthwhile.
“Although at times it has been challenging, it provides motivation to continue improving our processes and to continue updating ourselves with the best and most current evidence available,” he added.
UTMB’s ASP was established in 2016 after The Joint Commission, an international accreditation entity, released new regulatory guidelines requiring hospitals to establish such a program. Its role is to promote the appropriate use of antimicrobials, improve patient outcomes and reduce resistance of the bacteria the drugs are intended to combat.
The ASP’s initial efforts consisted of prospective audits and “handshake rounds,” ASP Pharmacy Leader Scott Ferren said, that involved walking around the hospital and providing recommendations to the teams.
“Meeting teams in person in the beginning helped us to become more visible to providers and to inform them that the program existed and can serve as a resource,” he said. “We also started implementing our first policies like pharmacist automatic IV to PO (oral) conversions and were able to show the impact of our work to earn more credibility and resources.”
From there, it added additional policies, including institutional guidelines for antimicrobial usage, and grew into a multidisciplinary group including stewards from the microbiology lab, infection control and health care epidemiology, clinical data management and IT, quality control specialists and nursing.
Initiatives undertaken by the ASP include:
- Developing its own institutional guidelines based on national and international practice recommendations
- Developing a real-time antibiogram and made it easier for providers to access it
- Updating the electronic health record (Epic) to provide information about infections and microbiology cultures in a way that made it easier to do the right thing
- Creating a clinical elective for internal medicine residents and infectious diseases fellows interested in learning more about ASP and getting hands-on experience
- Restricting and de-restricting antimicrobials
- Creating policies that regulate the use of meropenem and improve the management of deadly infections like Staph aureus bacteremia
- Saving the health system unnecessary costs of antibiotics and hospitalizations
- Improving the use of diagnostic testing—by limiting inappropriate blood and urine cultures and C diff testing—which in turn has improved the quality of antimicrobial use at UTMB
“Being one of the first members of this program, it is rewarding to have all the hard work and accomplishments of our antimicrobial stewardship program recognized as a Center of Excellence,” Ferren said.
UTMB’s stewardship team consists of Drs. David Reynoso, Natalie Williams-Bouyer, Philip Keiser and Janak Patel and infectious disease pharmacy specialists Scott Ferren, Rachel Britt, Noor Zaidan and Hiba Al Shaikhli.
“This designation serves as a validation for the work that our antimicrobial stewardship program does,” Ferren said. “We are constantly working to optimize antimicrobial usage at UTMB, and having an outside organization recognize our efforts validates the work that we do.”
Fewer than 200 hospitals across the United States, India and the United Arab Emirates currently hold IDSA’s Center of Excellence designation.
“Overall, we have grown our ASP and forged ourselves into allies and resources of providers who want to give their patients high-value, evidence-based care,” Reynoso said. “People in all departments welcome the ASP and our recommendations—and that is the most meaningful impact we could have wished for when we started this in 2016.”