Hospital Pharmacy - July/August 2017 - 509

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Bondarenka and Bosso
physician, pharmacist, and infection control practitioner and
guidance is provided for implementation and measurement of
stewardship initiatives in both hospitals and long-term care
facilities.13
After assessment of our needs and opportunities, we utilized the original IDSA/SHEA guidelines as a foundation for
the structure and operation of our ASP. The following is a
step-by-step review of the assessment and implementation
process, and a summary of the associated outcomes of the
program. Descriptions of the programmatic changes that have
been implemented over the past 7 years since the inception of
the ASP are also discussed. It is our hope that sharing our
approach will be of use to other health systems contemplating
the development and initiation of a stewardship program.

Overview of the Health System
Our health system is a 785-bed academic medical center affiliated with 6 colleges including Medicine and Pharmacy. The
average daily census of the medical center is approximately
700 patients, with approximately 47,000 admissions per year.
It comprises the Children's Hospital, Institute of Psychiatry,
the Cancer Center, 2 adult hospital entities, and the Eye
Institute. The Medical Center includes centers for specialized
care including the Heart Center, Transplantation Center,
Cancer Center, and Digestive Diseases Center, as well as
numerous physician-based outpatient facilities such as the
Family Medicine Center, University Diagnostic Center, and
other affiliated faculty practice ambulatory care centers.

Step 1: Baseline Evaluation to Support
Implementation of an Antimicrobial
Stewardship Program
Figure 1 outlines the steps utilized to plan, implement, and
adapt the ASP at our institution. According to the original
IDSA/SHEA Guidelines for Developing an Institutional
Program,12 there are both core and supplemental strategies that
should be deployed to develop a program and these were carefully weighed in contemplating our needs and priorities. In
2007, baseline data reflecting current efforts related to stewardship were evaluated to assess needs and then garner administrative support for funding of the program. The Anti-infective
Subcommittee of the Pharmacy and Therapeutics (P&T)
Committee already oversaw many initiatives around antimicrobial use such as trending utilization and resistance patterns,
reviewing formulary requests, and developing clinical pathways and orders sets. This committee remains intact today and
is led by an infectious diseases physician who is also the medical director of the antimicrobial stewardship team (AST)
resulting in an integral relationship between the committee
and the AST. The committee has always served as a sounding
board for AST proposals and receives and reacts to reports of
AST accomplishments. The AST often contributes agenda
items by presenting results from the AST or ideas for program

Figure 1. Steps for implementation of an ASP.
Note. ASP = antimicrobial stewardship program.

implementation. The secretary of the committee, a pharmacist, assists the chair in preparing the agenda, takes and distributes minutes, and is responsible for scheduling a meeting
time and location. The meeting is held once per month, in
person, and a quorum is always achieved, as there is great
commitment from the membership. Membership of the
committee is comprised of representatives from surgery,
infectious diseases, clinical microbiology, infection control
and prevention, the hospitalist service, specialties such as
hematology/oncology, solid organ transplant, pediatric
infectious diseases, and critical care which are all services
that heavily utilize antimicrobials. Both AST physicians and
both AST pharmacists are on this committee. The secretary
is also a member of the Infection Control Committee. This
overlap in committee appointment assures ongoing and
effective communication between major parties involved
with our stewardship program. The facility antibiogram is
updated annually by the clinical microbiology department and

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