Without good data, who’s to say whether U.S. providers’ programs to curb inappropriate antibiotic usage are having any effect? That’s a problem.
“There are numerous measures of antimicrobial use, and until we have an agreed-upon measure to provide standardized data, we will not be able to assess the effectiveness of our antibiotic stewardship programs [ASPs] on a national scale,” says Gina Pugliese, RN, MS, FSHEA, vice president of Premier Inc.’s Premier Safety Institute.
“We need additional research to identify sound outcomes measures to evaluate the effectiveness of the components of ASPs. At present there are many structural components – e.g., ‘Do you have an ASP in place?– and process components – e.g., ‘percentage compliance with an antibiotic time-out at 48 hours post-initiation of antibiotic therapy’ measures. In other words, to identify the critical components, we need quantitatively validated, evidence-based, prioritized ‘drivers’ of the best outcomes from ASP models.”
Work is underway at the federal and state level to generate the data needed to achieve that goal. One vehicle is the Centers for Disease Control and Prevention’s National Healthcare Safety Network Antimicrobial Use and Resistance (NHSN AUR) module.
Said to be the nation’s most widely used healthcare-associated-infection (HAI) tracking system, the NHSN provides facilities, states, regions, and the nation with data needed to:
- Identify infection prevention problems by facility, state, or specific quality improvement project.
- Benchmark progress of infection prevention efforts.
- Comply with state and federal public reporting mandates.
- Drive national progress toward elimination of healthcare-associated infections.
NHSN now serves over 13,000 medical facilities tracking HAIs. “NHSN AUR “has a standardized measure, and will be very helpful in achieving this goal of measuring our success with appropriate [antimicrobial] use and resistance,” says Pugliese. “Experts will be needed in each state to facilitate this and provide support and technical expertise and assistance to hospitals to assure success,” she adds.
Software can help
Meanwhile, the federal government is pushing providers and software developers to improve the quality and quantity of data on antibiotic resistance.
For example, the Obama Administration’s National Action Plan for Combating Antibiotic-resistant Bacteria, issued in March, calls for CMS to develop a tool to help software developers certify electronic health records and other health IT software for recording and submitting antimicrobial usage data. The plan also calls on CMS to complete an analysis of standards and terminologies for antimicrobial usage reporting to ensure alignment between NHSN reporting and CMS’s Hospital Inpatient Quality Reporting (Hospital IQR) program reporting.
In addition, the National Action Plan identifies the following milestones for reporting antibiotic usage in inpatient settings:
Within one year:
- CDC will finalize arrangements for the purchase of proprietary data on inpatient antibiotic use to supplement NHSN data until a larger number of hospitals begin to use the NHSN module for antibiotic use reporting.
- CDC will work with healthcare and public health partners to propose new healthcare-facility antibiotic use measures to the National Quality Forum.
Within three years:
- CDC will use data collected through the NHSN AU module to provide annual national estimates of aggregated inpatient antibiotic use and feedback to healthcare facilities on antibiotic use, indicating whether antibiotic use rates are above or below the national average.
- CDC will establish routine reporting of antibiotic use and resistance data from select hospital systems via the NHSN AU and AR modules.
- The Department of Defense will centralize its reporting of inpatient antibiotic use to NHSN. Within five years:
- CDC will provide estimates of inappropriate inpatient antibiotic prescribing rates by state and region, and use this data to target and prioritize intervention efforts.
Editor’s note: To learn more about the CDC’s NHSN Antimicrobial Use and Resistance (AUR) Module, go to www.cdc.gov/nhsn/PDFs/training/AUR-training.pdf
“The National Action Plan for Combating Antibiotic-resistant Bacteria, March 2015” can be viewed at www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf