Ahlberg, Anders

Morrison, Callen H.

English

George Washington University: Health Sciences Research Commons (HSRC)

Himmelfarb Health Sciences Library, The George Washington University Health Sciences Research Commons URGENT Matters School of Medicine and Health Sciences 7-26-2023 Antimicrobial Stewardship Programs: The Unique Challenges of Implementation in the Emergency Department Anders Ahlberg George Washington University Callen H. Morrison George Washington University Follow this and additional works at: https://hsrc.himmelfarb.gwu.edu/smhs_URGENT_Matters  Part of the Medicine and Health Sciences Commons Recommended Citation Ahlberg, Anders and Morrison, Callen H., "Antimicrobial Stewardship Programs: The Unique Challenges of Implementation in the Emergency Department" (2023). URGENT Matters. Paper 24. https://hsrc.himmelfarb.gwu.edu/smhs_URGENT_Matters/24 This Journal Article is brought to you for free and open access by the School of Medicine and Health Sciences at Health Sciences Research Commons. It has been accepted for inclusion in URGENT Matters by an authorized administrator of Health Sciences Research Commons. For more information, please contact hsrc@gwu.edu. Antimicrobial Stewardship Programs: The Unique Challenges of Implementation in theEmergency DepartmentAnders Ahlberg, Callen H. Morrison7/26/2023Like a comic book supervillain, the “superbug” lurks on the periphery of the medicalsystem, ready to rear its head if antibiotic prescribing patterns provoke it into action.Antimicrobial resistance seen in superbugs is a significant risk to public health and presentsdangerous implications for our ability to treat infections. Antimicrobial stewardship programs(ASPs) promote the adequate and accurate use of antimicrobials to mitigate the spread ofdrug-resistant organisms. The implementation of ASPs in US Emergency Departments (EDs) isassociated with several challenges due to the unique setting and the requirements of an ED.One challenge to the implementation of ASPs in EDs is the demand for rapid real-timedecision-making and rapid initiation of treatment, which can result in antimicrobial reviewprocesses being overlooked. Unless the ASP is built into the workflow, physicians might not beable to access the information in time to affect decision-making. Also, there is inherentdiagnostic uncertainty in the ED, and the limited information may contribute to potential overuseor misuse of antimicrobials. If the physician does not know what is going on, antibiotics may begiven as part of empiric treatment. Moreover, the patient's expectations of receiving antibioticsmay influence physicians to over-prescribe antibiotics. Patients who ask specifically forantibiotics may be more likely to receive them. Finally, ED physicians face great pressure fromhospital administration to start antibiotics with time-to-antibiotics serving as a measured qualitymeasure for a variety of serious bacterial infections; they face less pressure regarding theirjudicious use of antibiotics in patients that are less likely to have a bacterial infection.The core mission of the ASP is to promote staff awareness and adherence to establishedguidelines for antibiotic utilization. Educational initiatives are a big part of this effort. Yet, themere scheduling of educational initiatives is a challenge to staff working in a 24/7 EDenvironment. Instead of a traditional classroom format, the utilization of social behavioralinterventions such as peer comparisons has shown success to reduce inappropriate prescribingwithin the ED setting.1 Other ASP interventions that have shown effectiveness in the ED includehaving dedicated pharmacists stationed in the ED to assist with antimicrobial prescriptions. Inaddition, easy access to clinical guidelines and algorithms embedded within the electronic healthrecord may allow for more evidence-based antimicrobial use.2Ultimately, the goal of reducing the risks of new superbugs capable of overcoming ourstrongest antimicrobials requires a multi-pronged approach. Solving this problem requires thecollective effort of the healthcare community to recognize the problem, individual effort byphysicians to consider how patient-level decisions affect the public at-large, and a system-wideeffort to make guidelines more accessible, comprehensive care more feasible, and adherence toevidence-based practices more incentivized.The authors have no conflicts to reportReferencesMeeker, D., Linder, J. A., Fox, C. R., Friedberg, M. W., Persell, S. D., Goldstein, N. J., Knight,T. K., Hay, J. W., & Doctor, J. N. (2016). Effect of Behavioral Interventions on InappropriateAntibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA,315(6), 562–570. https://doi.org/10.1001/jama.2016.0275Buising, K. L., Thursky, K. A., Black, J. F., MacGregor, L., Street, A. C., Kennedy, M. P., &Brown, G. V. (2008). Improving antibiotic prescribing for adults with community acquiredpneumonia: Does a computerised decision support system achieve more than academic detailingalone?--A time series analysis. BMC medical informatics and decision making, 8, 35.https://doi.org/10.1186/1472-6947-8-35

Antimicrobial Stewardship Programs: The Unique Challenges of Implementation in the Emergency Department

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Antimicrobial Stewardship Programs: The Unique Challenges of Implementation in the Emergency Department

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