Issue link: https://beckershealthcare.uberflip.com/i/653703
36 ANTIBIOTIC RESISTANCE & STEWARDSHIP VA Leads the Way in Antibiotic Stewardship Efforts: 5 Things to Know By Shannon Barnet A Society for Healthcare Epidemiology of Ameri- ca study shows antibiotic stewardship practices are widely implemented at Veterans Affairs-affiliated facilities "The VA has been a national leader in the implementa- tion of antimicrobial stewardship programs," said co-lead study author Christopher Graber, MD, an infectious disease specialist at the VA Greater Los Angeles Healthcare System. According to Dr. Graber, the study "highlights how even though [antimicrobial stewardship programs] just started to emerge as an evidence-based strategy to com- bat antibiotic resistance, many VA facilities had coordinat- ed stewardship activities as well as staffing patterns that promoted appropriate antibiotic use." Here are five findings from the study. 1. Only 22 percent of facilities had a formal policy estab- lishing an antimicrobial stewardship program in 2012, when the study was conducted, but almost half (42 per- cent) of VA facilities had a program in development. 2. Thirty-eight percent of VA facilities reported having a multidisciplinary antibiotic stewardship team, including at least one physician and one clinical pharmacist. 3. A majority (80 percent) of facilities had at least one infec- tious disease specialist on staff in 2012, a position associat- ed with decreased antibiotic use. 4. Clinical pharmacists with infectious disease training as part of the antibiotic stewardship team were also associat- ed with a 10 percent decrease in antibiotic use. 5. Formal antimicrobial stewardship programs varied across the VA system, but nearly all facilities had at least some stewardship activities, including using antibiograms or guidelines for staff on effective antibiotic treatments (94 percent), formulary restrictions (92 percent) and restrictions on antibiotic duration (75 percent). n Behavioral 'Nudges' Help Reduce Antibiotic Prescriptions Among Physicians By Max Green A ppealing to clinicians' com- petitive nature and desire to strengthen their reputations may be an effective method for signifi- cantly reducing unnecessary antibiotic prescriptions, according to research published in JAMA. "Until now, most efforts to reduce anti- biotic prescribing have involved education, reminders or giving financial incentives to physicians," principal investigator and senior author Jason Doctor, PhD, director of health informatics for the University of Southern California Schaeffer Center for Health Policy and Economics in Los Ange- les, said in a statement. "We decided to test if socially motivated interventions, such as instilling pride in their performance or making physicians accountable for their decisions, would help address the problem. Our findings here suggest they may." In an 18-month study, researchers studied intervention strategies that on average reduced inappropriate antibiotic prescriptions for 1 in 8 patients seen. ey looked at three interventions, or "nudges," in particular: peer comparison, accountable justification and suggested alternatives. For the peer comparison component, clinicians received emails ranking them in order among their colleagues from highest to lowest number of antibiotics prescribed, which resulted in a 16 per- centage point reduction in prescription rates. Accountable justification, which prompted physicians when they entered patient EHRs to justify their reason for writing a prescription, was the most successful intervention, resulting in an 18 percentage point reduction. For the suggested alternatives intervention, which had no statistically significant effect, a pop-up window would encourage clinicians to use an alternative treatment when recording prescriptions in the com- puter system. "Recent clinical guidelines note that increased use of antibiotics is highly cor- related with antibiotic-resistant infections and that adverse reactions to antibiotics are implicated in an important subset of visits to emergency departments for adverse drug reactions," Marie Bernard, deputy director of the National Institute on Aging, which funded in the study in part, said in a statement. "is is an area we all need to pay attention to when treating patients of all ages." n "We decided to test if socially motivated in- terventions...would help address the prob- lem. Our findings here suggest they may." — Dr. Jason Doctor