Hospital Pharmacy Directors Research Articles

Hawke's Bay pharmacists' activities during a campylobacter contamination of public water supply in Havelock North during 2016.

INTRODUCTION In August 2016 contamination of the local water supply resulted in a significant gastroenteritis outbreak in Hawke's Bay. The significance of the initial test result was recognised early, partly as a result of information provided by a Havelock North pharmacist to health authorities about an unusual number of requests for anti-diarrhoeal medication. AIM To describe the breadth of activities undertaken by pharmacists working in Hawke's Bay in August 2016, following Campylobacter jejuni contamination of the public water supply in Havelock North, New Zealand. METHODS All pharmacists and hospital pharmacy management staff working in Hawke's Bay in 2017 were eligible to complete the qualitative online questionnaire. Additionally, information was requested from stakeholders with known relevant experiences. Free-text responses were thematically analysed using a general inductive approach. RESULTS Thirteen pharmacists and two ancillary staff from community pharmacy, hospital pharmacy, general practice, management, emergency response and dispensary management responded to the survey. Analysis of responses revealed three overarching themes and six sub-themes. The first was public wellbeing, with sub-themes of community information, local emergency response and pharmacy operational management. The second was pharmaceutical distribution, with a sub-theme of stock management. The third theme was clinical medicine management, with sub-themes of acute symptom management and medicine management. DISCUSSION The pharmacy profession appears to have played an important role in public wellbeing, pharmaceutical distribution and medicine therapy management during the outbreak. It is likely that through their actions, responding pharmacists reduced demand on other primary care services and prevented hospitalisations. Further research directions include exploring the effectiveness of community pharmacists in public health surveillance and the use of endorsed public health information to ensure consistent delivery of health messages.

Évolution du cadre juridique et normatif entourant l’exercice de la pharmacie hospitalière et le bon usage des médicaments au Québec

The objective was to identify the main texts applicable to the practice of pharmacy in Quebec, then count the specific number of recommendations and criteria and describe the evolution of the legal and normative framework. This is a descriptive and retrospective study of the main texts applicable to the legal and normative framework for the practice of pharmacy on January 1st, 2019. A total of 107texts relating to the practice of pharmacy in Quebec were identified. They come from the legislator (53.1%), the Order of pharmacists (26.1%) or other organizations (20.8%). These were laws/regulations (n=59), contributing to the optimal use of drugs (n=18), relating to hospital pharmacy management (n=18), the provision of pharmaceutical care (n=11), drug preparation (n=3), oncology practice (n=2) or health and safety at work (n=1). Thirty-three texts were considered for enumeration of recommendations and explicit criteria, for a total of 235recommendations and 3703explicit criteria applicable to the practice of hospital pharmacy in Quebec. There is a significant increase in the number of texts, recommendations and criteria applicable to the practice of hospital pharmacy in Quebec. Compliance with this legal and normative framework appears to be a considerable challenge for hospital pharmacists. It seems worthwhile to further promote discussion with text-issuing agencies in order to keep the search for compliance realistic.

Clinical Pharmacy Practice Patterns Among North Carolina Rural Hospitals

Introduction: Rural hospitals are isolated without adequate funding needed to provide for clinical services offered at larger health systems. The purpose of this study is to determine the clinical pharmacy services available and desired by rural hospitals in North Carolina. Methods: This prospective, cross-sectional, survey was distributed to a cohort of rural pharmacy directors and managers at rural hospitals across North Carolina. Data collected pertained to characteristics of the hospital and pharmacy, pharmacy director, clinical services, and responder impressions on their ability to maintain or enhance clinical services. Responses were summarized utilizing descriptive statistics and free-responses were coded for similar themes. Results: Seventeen respondents (32.6%) completed the survey. Clinical activities varied, as did characteristics of the hospitals and staff. Improved patient care is the primary reason why hospital pharmacies expand their clinical participation (46.7%). Pharmacy directors believed growth of clinical activities was a long-term goal while reporting regulations, staff, and finances as barriers to growth. Conclusion: Clinical pharmacy services vary in NC rural hospitals. Directors exhibit a willingness to expand clinical responsibilities. Rural hospital pharmacy directors desire pharmacists to be active clinically in patient care, but face barriers in reaching that goal.

Prevalence and Severity of Rationing During Drug Shortages

This study examines national survey results from hospital pharmacy managers to investigate current drug allocation and rationing practices of US hospitals during drug shortages.

Development of Managerial Key Performance Indicators for A Hospital Pharmacy Digital Dashboard.

Pharmaceutical performance is a critical factor in the hospital operation. Hospital pharmacy activities require retrieving, processing, comparing, and updating the information. Dashboards are new tools that can track key performance indicators by displaying information to managers in order to improve the performance of the hospital pharmacy. We conducted this study to determine the performance indicators of hospital pharmacies in Iran. This qualitative research was conducted in 2016. The participants were hospital pharmacists and hospital managers. A semi-structured questionnaire was constructed to determine key performance indicators of the hospital pharmacy department. The questionnaire was used in face-to-face interviews and focus groups. The data were analyzed using Framework analysis. The indicators comprised three domains, including managerial indicators (satisfaction, education, staffing, and department management), clinical indicators (patient safety), and financial indicators (income, costs, and financial utilization). Traditionally, pharmacy services included provision and distribution of drugs in the hospital; however, today, with an increase in the complexity and diversity of the drugs, hospital pharmacy services include diverse fields beyond clinical affairs. It could be concluded that pharmaceutical performance has a vital role in successful hospital management. Hospital pharmacy management is not possible without monitoring performance indicators.

Former ASHP Treasurer Joe E. Smith dies at 84

Joe Ephriam Smith, Pharm.D., who in 1967 decentralized the clinical and distributive pharmacy services of a large Pennsylvania hospital and later developed the first pharmacy technician training program to receive accreditation from ASHP, died of heart failure on August 22 at Hahnemann University Hospital in Philadelphia. He was 84 years old. Smith led pharmacy operations at Thomas Jefferson University Hospital in Philadelphia for 31 years, arriving when the facility, which now has 899 beds, was known as Jefferson Medical College Hospital. He received the highest honor in hospital pharmacy, the Harvey A. K. Whitney Lecture Award, in 1988. That same year Smith was named the fourth John W. Webb Visiting Professor in Hospital Pharmacy in recognition of his commitment to hospital pharmacy management and experience as an educator and practitioner. From 1989 to 1995, Smith served as the treasurer of ASHP. “Joe was an incredible individual, leader, and mentor to so many future pharmacy leaders,” said ASHP Chief Executive Officer Paul W. Abramowitz. “I had the honor of serving on the ASHP Board of Directors with Joe during his term as ASHP treasurer, and it was a great experience to have had the opportunity to interact with a true pharmacy legend who contributed so much to our great profession.”

PHP89 - CLASS CNN DRUGS IN ITALY: PURCHASE AND PRESCRIPTION BEHAVIOR IN ITALIAN HOSPITALS

The 2012 Law Decree (D.L. n. 158/12 “Decreto Balduzzi”), introduced new regulation regarding authorization and classification of EMA authorised drugs, awaiting AIFA price and reimbursement (P&R) assessment. Under this Decree, drugs are temporarily classified as “class C non-negotiated” (Cnn) with the treatment cost being borne directly by patients (retail prescription market) or by hospitals. Scope of Cnn class introduction was to accelerate availability of novel treatments, just after EMA approval. Pending AIFA evaluation and finalisation of the P&R scheme (class H, A, A-PHT, C), manufacturers can decide whether to market it or not. This circumstance left hospitals and part of the industry with some uncertainty on the practicability of Cnn-drugs acquisition. Scope of our research was to understand and map hospital purchasing attitudes towards Cnn-drugs across all 20 Italian regions. Desk-research on web-sites of National and Regional Authorities and Hospitals, was supplemented where necessary, by primary research conducted via structured questionnaire-based phone interviews to hospital pharmacy directors. Initial web-search produced law-references for 8/20 regions. Information for the remaining regions (12) was collected through telephone interviews to 30 selected hospitals (ca. 100 calls; 29 questionnaires submitted, 16 positive replies). Overall, 17/20 Regions allow Cnn-drugs purchase, yet hospital implementation occurs very rarely (1 or 2 patient cases/hospital in the past 12 months, according to the interviews). Across all analysis 14/20 Regional/Hospital policies allow Cnn-drug purchase only in the absence of valid AIFA-approved therapeutic alternative, or if manufacturer offers the drug at a very small nominal price (13/20). Italian hospitals can purchase Cnn-drugs, although their cost is not reimbursed by the NHS until AIFA reclassification. However, our research shows that this process is seldomly applied. Full AIFA P&R appraisal still represents the most significant and most undertaken approach to bring pharmaceuticals under the NHS reimbursement scheme in Italian market.

Hospital Pharmacy Management System and Future Development Approaches in Bangladeshi Hospital

The aim of this present work is to find out a suitable and updated hospital pharmacy management system for Bangladesh. Hospital pharmacy is considered as the heart of any hospital because all the departments like surgery, cardiology, nephrology, medicine, pediatric etc. are linked up with pharmacy section. Although the pharmaceutical sector of Bangladesh is enriched so much and the product is up to the mark but the improper management system in hospital pharmacies make the patient’s burden high. So, development is required in hospital pharmacy to ensure the proper choice, preparation, store, compounding and dispense of medicine as well as medical devices along with counseling for patient’s safety and compliance.Bangladesh Pharmaceutical Journal 20(2): 180-187, 2017

Description and analysis of hospital pharmacies in Madagascar

Madagascar's health care system has operated without formal hospital pharmacies for more than two decades. The gradual integration of pharmacists in public hospitals since 2012 will allow the structuring of this field. This study was conducted to characterize the current situation regarding all aspects relating to the general functioning of hospital pharmacies and the services provided. This qualitative research used semi-structured interviews. Interviewees' perceptions about the general organization and functioning of hospital pharmacies and details on services provided were collected. The 16 interviewees were Ministry of Health staff members involved in hospital pharmacy, hospital directors, medical staff members and hospital pharmacy managers. Interviews were recorded, translated into French if conducted in Malagasy, and fully transcribed. Verbatim transcripts were coded according to the themes of hospital pharmacy and topical content analysis was performed. The principal issue perceived by interviewees was the heterogeneity of the system in terms of technical and financing management, with a main impact on the restocking of pharmaceutical products. The drug supply chain is not under control: no internal procedure has been established for the selection of pharmaceutical products, the quantification of needs is complex, stock management is difficult to supervise, a standard prescription protocol is lacking, dispensing is performed by unqualified staff, no pharmaceutical preparation is manufactured in the hospitals and administration occurs without pharmaceutical support. Progressive structuring of efficient hospital pharmacy services using the Basel statements for the future of hospital pharmacy is urgently needed to improve health care in Madagascar.

Outpatient pharmacy steps in when community pharmacies shut down.

As Hurricane Irma approached central Florida on September 10, word spread that Florida Hospital Orlando had a pharmacy that was still open and serving the community, said hospital pharmacy director Heath R. Jennings. “The minute the patients got wind of that, they were lined up around the block,” he said. A year earlier, that would not have been the situation. When Hurricane Matthew passed along Florida’s eastern coastline in October 2016, the emergency staffing plan for the 1,393-bed medical center did not include the outpatient pharmacy. “We found out very quickly that we had a difficult time discharging patients” into a community with an upcoming or just-expired curfew, Jennings said. The medical center also found out quickly that people in general had difficulty finding places in the community to obtain medications immediately before or after a curfew, he said. Because of that, the medical center added its medical office building pharmacy and hospital lobby-level outpatient pharmacy to the hurricane plan. “They’re all on generator power, and they would be considered safe haven places for employees,” Jennings said.

A design thinking framework and design patterns for hospital pharmacy management

ABSTRACT Nowadays, several hospitals are still suffering from inefficient processes. Redesigning business processes is an effective way for improvement. However, business process mapping and analysis in healthcare environment has become a complex task. Besides, most healthcare professionals often resist change. To deal with these obstacles, a design thinking framework and design patterns useful for modelling and simulation are proposed in this article. Initially, current problems focusing on hospital pharmacy management are identified through empirical investigation. According to the problems, the suitable solutions are determined based on the related literature. Afterwards, the holistic view of problems and their solutions with different aspects can be structured as the design thinking framework. For each solution, the design patterns are represented through various attributes including pattern name, purpose, description, modelling structure using a business process modelling notation. Likewise, the attributes facilitated to simulation modelling are also combined such as control variables and performance measures. Here, based on the crucial problem that mostly concerned in any hospital case studies, the design pattern related to the problem of inefficient inventory management policy is illustrated and verified. Through a design thinking framework and design patterns, business users or process modellers can rapidly understand the context of problems and conduct a successful simulation study. It can be a valuable tool to redesign healthcare systems.

National Survey of Hospital Medication Safety Practice during Mass Gathering (Hajj-2016) in Makkah, Saudi Arabia: Medication Preparation and Dispensing

Objective: To explore the national survey of hospital medication safety practice during mass gathering (Hajj -2016) in Makkah, Saudi Arabia: Medication preparation and dispensing, the finding of ISMP (2011) self-assessment of medication safety at the hospitals. Methods: It is 15 days cross-sectional national survey of hospital medication safety at Makkah region. The survey modified from Institution of Safe Medication Practice (ISMP) self-assessment of hospital medication safety. It consisted of a demographic section and ten domains with 270 questions. The ten areas included patient information, drug information, communication of medication orders, drug preparation, medication distribution, medication devices, work environment, staff competency, patient education, quality process with risk management domain. The 5-points Likert response scale system used. The survey distributed to sixteen directors of hospital pharmacy during mass gathering Hajj-2016. The medications safety officer at Makkah region distributed the questionnaire and made follow up on a daily basis used physical visiting and through the telephone call. Results: The survey distributed to sixteen hospitals, the response rate, was eleven hospitals (68.75%). The total score of all ISMP-self assessment of medication safety was 3.39 +/-0.51 (67.68 %) with CI (3.2-3.6) P Key words: Medication Safety, Hajj, Drug, Preparation, Dispensing, Ministry of Health, Saudi Arabia.

National Survey of Hospital Medication Safety Practice during Mass Gathering (Hajj-2016) in Makkah, Saudi Arabia: Environmental Culture and Staff Competency

<p style="text-align: justify;"><strong>Objective:</strong> To explore the national survey of hospital medication safety practice during mass gathering (Hajj -2016) in Makkah, Saudi Arabia: Environmental factors and staff competency, the finding of ISMP (2011) self-assessment of medication safety at the hospitals. <strong>Methods:</strong> It is 15 days cross-sectional national survey of hospital medication safety at Makkah region. The survey modified from Institution of Safe Medication Practice (ISMP) self-assessment of hospital medication safety. It consisted of a demographic section and ten domains with 270 questions. The ten areas included patient information, drug information, communication of medication orders, drug preparation, medication distribution, medication devices, work environment, staff competency, patient education, quality process with risk management domain. The 5-points Likert response scale system used. The survey distributed to sixteen directors of hospital pharmacy during mass gathering Hajj-2016. The medications safety officer at Makkah region distributed the questionnaire and made follow up on a daily basis used physical visiting and through the telephone call. <strong>Results:</strong> The survey distributed to sixteen hospitals, the response rate, was eleven hospitals (68.75%). The total score of all ISMP-self assessment of medication safety was 3.39 +/-0.51 (67.68 %) with CI (3.2-3.6) P&lt; 0.05. The average rating of environmental factors, workflow, and staffing were 3.93 (78.6 %) while the mean score staff competency and education domain at all hospital were 3.69 59.40%). The highest score of both domains was a standard lighting adequate to read labels and other important drug and patient information in pharmacies 4.70 (94 %). The lowest score of both domains was The organization provides formal teamwork training to all staff 2.91 (58.2%). <strong>Conclusion:</strong> The medication safety related environmental factors, workflow, and staff competency key element during mass gathering Hajj period was right level. The levels of both domains required to continue in the coming next years with focusing on using the new technology of pharmacy practice at hospitals and annual assessment medication safety culture during mass gathering Hajj period at all hospitals in Makka region, Saudi Arabia highly recommended. <p style="text-align: justify;"><strong>Key words:</strong> Medication Safety, Hajj, Environmental, Staff, Competency, Ministry of Health, Saudi Arabia.

National Survey of Hospital Medication Safety Practice during Mass Gathering (Hajj-2016) in Makka, Saudi Arabia: Medication Administration

Objective: To explore the national survey of hospital medication safety practice during mass gathering (Hajj -2016) in Makkah, Saudi Arabia: Medication Administration, the finding of ISMP (2011) self-assessment of medication safety at the hospital. Methods: It is 15 days crosssectional national survey of hospital medication safety at Makkah region. The survey modified from Institution of Safe Medication Practice (ISMP) self-assessment of hospital medication safety. It consisted of a demographic section and ten domains with 270 questions. The ten areas included patient information, drug information, communication of medication orders, drug preparation, medication distribution, medication devices, work environment, staff competency, patient education, quality process with risk management domain. The 5-points Likert response scale system used. The survey distributed to sixteen directors of hospital pharmacy during mass gathering Hajj-2016. The medications safety officer at Makkah region distributed the questionnaire and made a follow-up on a daily basis used physical visiting and through the telephone call. Results: The survey distributed to sixteen hospitals, the response rate, was eleven hospitals (68.75%). The total score of all ISMP-self assessment of medication safety was 3.39 +/-0.51 (67.68 %) with CI (3.2-3.6) P Key words: Medication Safety, Hajj, Drug, Administration, Ministry of Health, Saudi Arabia.

National Survey of Hospital Medication Safety Practice during Mass Gathering (Hajj-2016) in Makkah, Saudi Arabia: Drug Information

Objective: To explore the national survey of hospital medication safety during mass gathering (Hajj -2016) in Makkah, Saudi Arabia: Drug Information, the finding of ISMP (2011) self-assessment of medication safety at the hospitals. Methods: It is 15 days cross-sectional national survey of hospital medication safety at Makkah region. The survey modified from Institution of Safe Medication Practice (ISMP) self-assessment of hospital medication safety. It consisted of a demographic section and ten domains with 270 questions. The ten areas included patient information, drug information, communication of medication orders, drug preparation, medication distribution, medication devices, work environment, staff competency, patient education, quality process with risk management domain. The 5-points Likert response scale system used. The survey distributed to sixteen directors of hospital pharmacy during mass gathering Hajj-2016. The medications safety officer at Makkah region distributed the questionnaire and made follow up on a daily basis used physical visiting and through the telephone call. Results: The score of total score of all ISMP-self assessment of medication safety was 3.39 +/-0.51 (67.68 %) with CI (3.2-3.6) P Key words: Medication Safety, Hajj, Drug, Information, Ministry of Health, Saudi Arabia.

National Survey of Hospital Medication Safety Practice during Mass Gathering (Hajj-2016) in Makkah, Saudi Arabia: Patient Education, Quality Process, and Risk Management

Purpose: To explore the national survey of hospital medication safety practice during mass gathering (Hajj -2016) in Saudi Arabia, finding from ISMP (2011) self-assessment of medication safety at the hospital with emphasis on Patient education, quality process, and Risk Management. Methods: It is 15 days cross-sectional national survey of hospital medication safety at Makkah region. The survey modified from Institution of Safe Medication Practice (ISMP) self-assessment of hospital medication safety. It consisted of a demographic section and ten domains with 270 questions. The ten areas included patient information, drug information, communication of medication orders, drug preparation, medication distribution, medication devices, work environment, staff competency, patient education, quality process with risk management domain. The 5-points Likert response scale system used. The survey distributed to sixteen directors of hospital pharmacy during mass gathering Hajj-2016. The medications safety officer at Makkah region distributed the questionnaire and made follow up on a daily basis used physical visiting and through the telephone call. Results: The survey distributed to sixteen hospitals, the response rate, was eleven hospitals (68.75%). The total score of all ISMP-self assessment of medication safety was 3.39 +/- 0.51 (67.68 %) with CI (3.2-3.6) P Key words: Medication Safety, Hajj, Patient education, Quality Process, Risk Management, Ministry of Health, Saudi Arabia.

National Survey Of Medication Safety Practice At Ministry Of Health Hospitals During Mass Gathering (Hajj-2016) In Saudi Arabia

To explore the medication safety practice at Ministry of Health (MOH) hospitals during mass gathering (Hajj -2016) in Saudi Arabia It is a 15-days cross-sectional national survey of medication safety practice at Makkah hospitals during mass gathering Hajj period. The survey modified from Institution of Safe Medication Practice (ISMP) self-assessment of medication safety practice at hospitals. It consisted of a demographic section and ten domains with 270 questions. The ten areas included patient information, drug information, communication of medication orders, drug preparation, medication distribution, medication devices, work environment, staff competency, patient education, quality process with risk management domain. The 5-points Likert response scale system used. The survey distributed to sixteen directors of hospital pharmacy during mass gathering Hajj-2016. The medications safety officer at Makkah region distributed the questionnaire and made follow up on a daily basis used physical visiting and through the telephone call. The study made as an electronic format, and it analyzed through survey monkey system The survey distributed to sixteen hospitals, the response rate, was eleven hospitals (68.75%). Of those 4 (36.4%) hospitals bed size was (100-199) and 3 (27.3%) bed size (200-299). The responded 4(36.4%) hospitals were accredited by Saudi Central Board of Hospitals Accreditation (CBAHI) while 3 (27.3%) accredited by USA International Joint Commission and CIBAHI. The whole sections score of all hospital were (66.4 %). Of the ten domain the patient information was (57.2%), Drug Information (58%), communication of medication orders (70.5%), drug preparation (73.7%), medication distribution (70.22%), medication devices (59.3%), work environment (78.62%), staff competency (73.86%), patient education (74.9 %), and quality process with risk management (62.96 %). The potential medication safety practice was the lowest score, and it was patient information and drug information field. Targeting to correct all related medication safety issues prevent drug misadventures, improved patient clinical outcomes, and quality of life.

A Management and Special Pharmacy Services Course for Pharmacy Students

Abstract: Purpose: To describe the designing and implementation of a Management and Special Pharmacy Services course. Methods: According to the typology of teaching activity established by the Ministry of Higher Education of Cuba a course was designed. The course was focus on the development and management of innovative practices in all areas of pharmacy practice. To assess the students’ perceptions related to the course a 9-item survey was distributed to 25 students. Results: All students returned the survey. Of the respondents, 91% strongly agreed or agreed that the objectives for student learning were met and 71% agreed that the course furthered their understanding of the impact of managed care and pharmacy management, and increased their competency to practice pharmacy. Conclusion: Management education experiences such as this course will help better prepare our next generation of community and hospital pharmacy managers. Key words: Pharmacy Management Education, Pharmaceutical Care, Social Pharmacy, Pharmacy Education, University.

Description of hospital pharmacy management practice

Health institutions, particularly hospitals, are characterized as complex structures that need managers with a global view of the institution and its relations with the external environment. The hospital pharmacy is a strategic unit, which cooperates with the institutional management and integrates the multiprofessional team in the process related to the acquisition, provision and control of essential inputs for the inpatient care process. The objective in this study is to demonstrate the applicability, in the context of hospital-based health, of a performance measuring system at the pharmacy. Method: A descriptive and longitudinal study was undertaken on the evolution of the key indicator Absence Rate of Standardized Drugs in inpatient care between March 2004 and December 2013. This indicator was employed to monitor the impact of changes the Pharmacy Division has been implementing, as the first step of the pharmaceutical care cycle in the model of the process-based managed approach at a public university hospital. Qualitative data collection methods were used, including observation and documentary analysis, as well as quantitative data collection. Results: After the application of the model, one point of change in the key performance indicator was detected in the tenth month, when the process-based management model was implemented at the pharmacy. Conclusions: The process-based management approach was effective for the hospital pharmacy. The premise adopted is that the administrative changes (interferences), focused on the improvement of the processes and the selection and monitoring of indicators, influence the processes, reducing the variability and improving the quality

Impact of a national antimicrobial stewardship mentoring program: Insights and lessons learned.

The impact of an interprofessional mentoring program to advance antimicrobial stewardship programs (ASPs) in selected U.S. hospitals and lessons learned are described. A seven-step mentoring process with self-assessment, telephone calls, continuing education, a one-day onsite visit, action plan, and outcome data collection and analysis was provided to ASP teams at nine hospitals. Six hospitals completed the program. A significant improvement in the timeliness and appropriateness of i.v. antibiotic therapy (defined as a hang time within one hour after prescriber order entry and broad-spectrum coverage for gram-negative pathogens administered first when combination therapy was used) was observed in patients with sepsis over the 12-month period after implementation of the mentoring program. As a result of requiring hospital administration's participation in the mentoring program, increased funding became available at three hospitals for the microbiology laboratory to provide new rapid diagnostic tests and for pharmacist and physician time to devote to ASP activities. The collaboration and engagement of ASP team members, inclusion of hospital administrators and pharmacy directors in the onsite mentoring visits, and an experienced mentor team with an infectious diseases (ID) physician and ID pharmacist contributed to ASP success. Challenges included insufficient time to collect outcome metrics due to competing hospital priorities and loss of momentum over time. A mentoring program for antimicrobial stewardship provided the perspective that comes from experience. Engagement of hospital administration was a key factor for both developing and sustaining a stewardship program.