Application of Standardized Antimicrobial Administration Ratio as a Motivational Tool within a Multi-Hospital Healthcare System.

Stephanie Shealy,Casey Troficanto,Emily Yongue,P Brandon Bookstaver,Hana R Winders,Joseph Kohn,Julie Ann Justo,Sangita Dash,Majdi N Al-Hasan

doi:10.3390/pharmacy9010032

Abstract

The standardized antimicrobial administration ratio (SAAR) is a novel antimicrobial stewardship metric that compares actual to expected antimicrobial use (AU). This prospective cohort study examines the utility of SAAR reporting and inter-facility comparisons as a motivational tool to improve overall and broad-spectrum AU within a three-hospital healthcare system. Transparent inter-facility comparisons were deployed during system-wide antimicrobial stewardship meetings beginning in October 2017. Stakeholders were advised to interpret the results to foster competition and incorporate SAAR data into focused antimicrobial stewardship interventions. Student’s t-test was used to compare mean SAARs in the pre- (July 2017 through October 2017) and post-intervention periods (November 2017 through June 2019). The mean pre-intervention SAARs for hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Hospital B experienced significant reductions in SAAR for overall AU (from 1.09 to 0.83; p < 0.001), broad-spectrum antimicrobials used for hospital-onset infections (from 1.36 to 0.81; p < 0.001), and agents used for resistant gram-positive infections in the intensive care units (from 1.27 to 0.72; p < 0.001) after the interventions. The alignment of the SAAR across the health-system and sustained reduction in overall and broad-spectrum AU through implementation of inter-facility comparisons demonstrate the utility in the motivational application of this antimicrobial use metric.

Highlights

Antimicrobial stewardship programs (ASPs) have long sought a standardized method for benchmarking antimicrobial use, allowing comparative antimicrobial stewardship metrics between hospitals and assessment of the effectiveness of targeted interventions [1,2,3]
Large healthcare systems may be able to internally develop a robust approach to antimicrobial use benchmarking [5]. The utility of these tools may be limited in smaller healthcare systems and community hospitals. In response to this need, the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) introduced the standardized antimicrobial administration ratio (SAAR) as a metric included in the antimicrobial use option [6]
The ASP consists of an infectious diseases physician and pharmacist leads in each hospital who meet regularly to discuss issues related to antimicrobial use as well as develop and sustain focused antimicrobial stewardship interventions

Summary

Introduction

Antimicrobial stewardship programs (ASPs) have long sought a standardized method for benchmarking antimicrobial use, allowing comparative antimicrobial stewardship metrics between hospitals and assessment of the effectiveness of targeted interventions [1,2,3]. The utility of these tools may be limited in smaller healthcare systems and community hospitals In response to this need, the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) introduced the standardized antimicrobial administration ratio (SAAR) as a metric included in the antimicrobial use option [6]. Facilities should be aware of potential seasonal variation in the SAAR [8] Despite these limitations, the SAAR is considered the most direct metric for the measurement of antimicrobial stewardship performance [9]. To encourage antimicrobial use option participation, the CDC specifies tracking of antimicrobial use and reporting to NHSN as a priority to achieve the core elements of hospital antibiotic stewardship programs [10]

Methods

Results

Conclusion