Salud13 febrero, 2024

Data analysis in antibiotic stewardship

De: Steve Mok, PharmD, MBA, BCPS, BCIDP
Abstract big data line background

Analytics and big data are frequently used buzzwords in the healthcare industry that promise a bright future that would revolutionize patient care and outcomes. 

In this article, we will examine how antimicrobial stewards can harness the power of data analytics to gain valuable insights on how to improve antimicrobial use in their organizations today.

One of the most important benefits of analytics is the enablement of program leaders to make informed decisions. In today’s healthcare environment where clinicians are tasked with more activities with less available resources, leaders must optimize the allocation of time and energy to maximize their returns. Data helps leaders identify specific targets in their process and performance improvement efforts and enables the measurement of impact to determine if the interventions are achieving the desired outcomes.

Stewardship key processes and outcome measures

The importance of data is emphasized in the Joint Commission Antimicrobial Stewardship standards, element of performance 20: “The antibiotic stewardship program collects, analyzes, and reports data to hospital leadership and prescribers.” The tracking and report of key process and outcome measures were also identified as key components in the CDC Core Elements of Antimicrobial Stewardship.

The data elements most tracked by antimicrobial stewardship programs can be categorized as either process or outcome measures. Process measures help you track how well you perform tasks associated with your program, whereas outcome measures assess the effect of your interventions. One of the most obvious outcome measures for antimicrobial stewardship programs is antimicrobial use. This was discussed in detail in a previous article of this series. Other example key metrics that may be measured include:

Process measures

Outcome measures

Types and acceptance of interventions

Antibiotic resistance

Adherence to hospital guidelines and protocols

  Secondary infections

IV to PO conversion rates

  % of antimicrobials administered by IV
Unnecessary duplicate coverage
  Financial impact

Antimicrobial stewardship leaders and pharmacy personnel should document their activities, such as prospective audits and feedback or de-escalation, to enable the collection of data to measure the effectiveness of their program interventions. Preferably these interventions are documented electronically, with pre-defined selection so that meaningful analysis can be performed. Free text entries often make subsequent analysis and reporting labor-intensive and time-consuming.

Identifying intervention opportunities to drive continuous improvement

Tracking the types and acceptance of antimicrobial recommendations may reveal opportunities for more systematic interventions to improve antimicrobial use, such as formulary restriction, pre-authorization, optimizing order sets, and education.  Adherence to treatment and stewardship guidelines should also be tracked, not just to satisfy the Joint Commission medication management standards, but also to help antimicrobial stewardship teams identify opportunities for improvement. For example, low performance for de-escalation may indicate additional pharmacy resources shall be deployed for reviewing microbiology results, whereas prolonged time from susceptibility results to performing de-escalation may indicate potential benefit from deploying real-time clinical decision support alerts to ensure patients do not receive broad-spectrum antimicrobials than necessary. A real-time clinical surveillance system notifies clinicians of de-escalation opportunities, among other interventions, as soon as culture results are reported in the electronic health record.

Example of a real-time alert notifying pharmacist of an opportunity to de-escalate vancomycin therapy for an MSSA infection.

MSSA Treatment StreamliningAntimicrobial regimen review alert to identify patients whose therapy may be de-escalated.
Relevant DrugsAntimicrobial therapy review panel
Culture-BloodIn-line microbiology results displayed within alert panel to support quick decision making.

Antimicrobial stewardship outcomes measurement

Outcome measures that can be used to track the performance of an antimicrobial stewardship program often include antimicrobial usage such as Days of Therapy (DOT), antimicrobial resistance for key organisms, and antimicrobial expenditures. Program leaders shall review these metrics regularly to assess the impact of their programs. Pairing process and outcome measures together can sometimes be helpful if desired outcomes are not achieved. Antimicrobial stewardship programs design useful, evidence-based interventions and system approaches to drive optimal antimicrobial use. However, when such program interventions are not performed consistently, the patients and hospitals do not realize the benefits from the meticulously designed programs.  Therefore, tracking these process measures can often help antimicrobial stewardship leaders quickly diagnose any potential issues in the implementation of their tactics.

For example, IV to oral conversions have been shown to reduce the number of IV line days and the risk of developing line related infections. An outcome measure that could be tracked includes the percentage of DOTs administered via IV and oral routes. If the percentage of IV administration for a particular antimicrobial is trending up, the program leader may want to assess process measures to determine how often those opportunities are acted upon. Program leaders may wish to work with pharmacy leadership to allocate sufficient resources to perform more of these evidence-based interventions and to hold key personnel accountable for completing these interventions. 

Example of measuring % of antimicrobial administered by IV route and performance dashboard to antimicrobial stewardship alerts in a clinical surveillance system.

Intravenous Use by Agent.jpg
Rule Performance

Automate tasks and tracking to sustain ASP improvements

Common wisdom in healthcare and business is that “what gets measured gets done”. However, we recognize that these measurements can be time-consuming and labor-intensive. It’s important to not spend so much time measuring that no actual doing is occurring! Antimicrobial stewardship leaders should leverage technology as much as possible to automate these metric collection tasks so that more time can be spent at the bedside providing patient care, and interfacing with prescribers to educate and conduct handshake stewardship. Thus, regulatory bodies such as the Joint Commission and the CDC recommend leadership commitment and allocation of financial and technical resources as key components of any antimicrobial stewardship programs. 

Antimicrobial stewardship leaders should take advantage of real-time clinical surveillance systems to identify opportunities for optimizing antimicrobial use daily. Furthermore, health information technology teams should provide access to modern analytics solutions to automate the collection of data, so that your time can be spent in higher-level analysis instead of gathering and compiling data points. Powerful analytics can help reveal key drivers of antimicrobial use and prioritize precious time and resources to the most problematic areas that require your utmost focus and attention.

Explore Sentri7 Antimicrobial Stewardship
Explore Sentri7 Antimicrobial Stewardship
Steve-Mok
Steve Mok, PharmD, MBA, BCPS, BCIDP
Manager of Pharmacy Services and Fellowship Director
Dr. Steve Mok has over a decade of experience in the areas of antimicrobial stewardship, infectious diseases and clinical pharmacy management. He has practiced in a variety of settings.

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