Antimicrobial Stewardship Program Leading State

December 8, 2022

Community Hospital has excelled in developing a quality program to manage administration of antibiotic use for best patient outcomes, according to experts at the University of Nebraska Medical Center.

Antimicrobial Stewardship. It’s not a phrase used by the average layperson, yet it is an essential practice to keep patients safe from overuse and resistance to antibiotics. The practice of antimicrobial stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients.

And Community Hospital is excelling in its antimicrobial stewardship program. “At an Antimicrobial Stewardship Meeting last month, UNMC told us we were only the ninth hospital in the state to start submitting antibiotic usage data to the Centers for Disease Control and Prevention’s NHSN (National Healthcare Safety Network),” said Anthony Rodewald, Community Hospital Director of Pharmacy. “We are also the first critical access hospital (under 25-bed hospital) in Nebraska to do so,” he added.

Trevor Van Schooneveld, MD, Medical Director of the Antimicrobial Stewardship Program at UNMC had this to say about Community Hospital, “Community Hospital is setting the standard for what small hospital antimicrobial stewardship should look like. Your program has been consistently forward thinking in their approach to appropriate antibiotic use. It is an example that other hospitals could learn from.”

Rodewald explained that in 2014 the CDC called on all US hospitals to implement and expand effective stewardship programs based on “The Core Elements of Hospital Antibiotic Stewardship Programs.” Since then, the CDC has used the NHSN annual hospital survey to query hospitals about their implementation of the core elements. Nationwide, only 26% of hospitals with 25 or fewer beds (critical access hospitals) have reported meeting all seven core elements, according to the CDC website.

“While small and critical access hospitals face special challenges in implementing the CDC core elements,” the website stated, “in part due to limitations in staffing, infrastructure and resources, antibiotic stewardship is no less important in these settings. Patients in small and critical access hospitals have not been spared the problems of antibiotic resistance and C. difficile. However, small and critical access hospitals also have some factors that can support improvements in care, as they are often tight-knit communities where collaboration is the norm,” it explained.

In Community Hospital’s efforts to implement some of these core elements, Rodewald said the hospital entered into a contractual relationship with UNMC in 2020. “We were the first hospital to enter into such a relationship with UNMC.”  Under the contract, the Infectious Disease – Antimicrobial Stewardship Team at UNMC provides services such as:

  • Daily review of antimicrobial therapy with Community Hospital pharmacy staff.
  • Review of microbiology culture results from the regional lab to follow up with patients discharged from the hospital
  • Provide recommendations to maintain a compliant stewardship program
  • Provide regularly scheduled webinars on infectious diseases/stewardship-related topics
  • Provide remote coaching for policy and guideline development and review
  • Provide remote coaching for individual stewardship-related case input from an infectious disease physician

“Even with this contractual relationship in place, CH still did not have the ability to gather two key metrics for antimicrobial stewardship,” he said. These included: 1) our own local antibiogram —a document that provides local resistance data, and 2) inability to submit Antibiotic Usage data to the state and CDC databases, which would give Community Hospital the ability to benchmark antibiotic prescribing against other facilities.

In March 2022 Community Hospital was able to implement software, called Sentri7, that allowed the hospital and pharmacy department to start reporting the necessary metrics, making Community Hospital the first critical access hospital in the state and the ninth hospital overall to do so.

Rodewald gives credit to the other pharmacists on his team, Dr. Lindsey Smith, Dr. Lori Ryland, and Dr. Chase Crawford, for their work on this quality initiative. “My staff took the bulk of the daily calls once we got the program up and running. They also did the majority of the culture reviews after discharge as well,” he said.

In its quest for a quality antimicrobial stewardship program, Community Hospital has received kudos from others:

"Antibiotics are the only medications that become less useful over time even if used correctly. They are a shared resource, and inappropriate use causes harm to both the patient and others. Improving antibiotic use is critical to our patients’ safety and the future of medicine. The primary goal of antibiotic stewardship is better patient care. In partnership with Nebraska Medicine, the pharmacy team at Community Hospital has been diligent at optimizing appropriate use- promoting the use of the right agent at the correct dosage and for the proper duration, as well as leading the way in other clinical initiatives." - Jeremy Tigh, PharmD, Division of Infectious Diseases, UNMC, Omaha, Nebraska

"Anthony Rodewald and the team at Community Hospital in McCook, Nebraska have developed a robust and meaningful Antimicrobial Stewardship Program (ASP) that is a great model for all critical access hospitals and is positively impacting patient care. Over the course of my time working with their team, they continually demonstrated a desire to learn and better themselves and their program, and this desire has been reflected in their continual improvement and implementation of treatment guidance, reporting structures, and other stewardship interventions. Community Hospital providers have increasingly asked for and accepted antibiotic recommendations from the pharmacy team and Nebraska Medicine Remote Antimicrobial Stewardship Support Program, and it has been exciting to watch the growth of the program. I am appreciative of the work Anthony and the Community Hospital - McCook team have done to improve antibiotic use, slow the spread of antibiotic resistance, and provide great care for patients!" - Andrew B. Watkins, PharmD, BCIDP, Antimicrobial Stewardship Pharmacist , St. Dominic Jackson Memorial Hospital, Jackson., Mississippi