Pharmacists step in when antimicrobial stewardship programs lack on-site ID support

Researchers found that the responsibility for antimicrobial stewardship programs at Veterans Affairs hospitals that did not have support from an infectious disease specialist often fell to pharmacists.

“Surveys have shown that up to half of U.S. hospitals lack an ID physician or ID pharmacist,” Daniel J. Livorsi, MD, an assistant professor of internal medicine at the University of Iowa Health Care, told Healio Primary Care. “It is not clear how antibiotic stewardship programs are best implemented when there is no ID specialist to take the lead.”

Livorsi and colleagues interviewed 42 health care workers at seven acute care hospitals with ASPs that were not supported by an on-site ID specialist. They asked about the “feasibility, appropriateness and acceptability of implementing different antibiotic stewardship strategies.” Most of the employees were clinical pharmacy specialists, but they also included hospitalists, administrators, microbiologists, off-site ID physicians, ED or urgent care physicians and nurse practitioners. Three of the hospitals were in rural locations, six were associated with a nursing home and the median number of beds across all locations was 18.

According to the researchers, several themes surfaced in the interviews:

• ASP pharmacist champions — or those who took on the responsibility of the ASP at the hospital in the absence of ID specialist support — wore “many hats” and had “many roles.”
• The pharmacist champions were more successful at getting buy-in for ASP activities when they had a rapport with clinicians, but sometimes the use of contract physicians as well as staff turnover posed challenges.
• Some believed off-site ID physicians were helpful in overcoming institutional barriers to ASPs and improved acceptance of them.
• Generally, stewardship champions struggled to get enough resources, making it difficult achieve their goals.

Livorsi said the lack of physician co-leadership of ASPs “made it challenging for the stewardship pharmacists to gain traction with their initiatives.”

However, the most concerning theme was the lack of institutional resources, he said.

“Some, but not all, of the stewardship programs had trouble mobilizing institutional resources to improve antibiotic‐prescribing,” Livorsi explained. “To me, this suggested that some of the hospitals were funding stewardship programs but were not necessarily invested in helping the programs achieve their goals.”