In this case study, the institution being assessed was a community hospital averaging 250 beds with an average length of stay of 3.72 days. Annual admissions are approximately 17,500 for a total of 65,000 patient days. There are five intensive care units, each of 8 to 12 beds. The overall Medicare acuity index for this facility during the assessment was 1.45. Following a series of interviews and examination of data as well as a review of on-site policies and procedures, Visante made several major recommendations for this hospital that are currently being implemented.
Examples of the types of recommendations that may come from these assessments are as follows:
1. Develop a set of performance standards for improving antibiotic use that are routinely measured, and an ongoing process to review results and take action to improved them where appropriate.
2. Create and implement guidelines for treatment of common infections to improve antibiotic use. Optimise duration of therapy while within the hospital and at discharge, if needed.
3. Flow chart antibiotic ordering and dispensing process from the time an order is written until the time the first dose is administered. From this bottlenecks can be identified and action taken to reduce or eliminate them.
4. Increase clinical involvement and supervision of the microbiology program.
5. Routinely review written pharmacist chart notes to medical staff as part of a quality improvement effort.
6. Develop standard protocols for cart notes or other preferred methods to contact and inform physicians.
7. Fortify the institution’s antimicrobial stewardship committee to include physician leadership.
8. Committee should also include representatives from microbiology, pharmacy and infection prevention/control areas.