Antimicrobial resistance (AMR) is a significant and global threat, in which antibiotics, antifungals and antivirals no longer work effectively to combat their respective infectious vectors. This is something that happens over time due in part to the misuse and overuse of antimicrobials, and it’s estimated that AMR could cause or contribute to 39 million deaths between 2025 and 2050.
ECU Health’s Antimicrobial Stewardship Program (ASP), co-led by a group of infectious diseases (ID) physicians and pharmacists, addresses this threat by encouraging the appropriate use of antimicrobials, optimizing patient care, minimizing adverse patient effects, preserving the utility of antimicrobials and minimizing the development of AMR.
This is done through daily patient-specific antimicrobial use recommendations, including drug choice, drug dose, route of drug administration and duration of therapy.
The ASP also conducts a rigorous review and development of antimicrobial restrictions, guidelines, policies and protocols, including ECU Health’s facility-specific treatment guidelines and an educational health system quarterly ASP newsletter. They track, analyze and report antimicrobial use and ASP outcome data quarterly (including data benchmarking ECU Health to other health systems), develop quality improvement/research projects to further investigate pertinent system/clinical questions and spend significant time educating future generations of pharmacists and providers. They also offer an American Society of Health-System Pharmacy (ASHP) accredited, postgraduate year two (PGY2) Infectious Diseases Specialty Pharmacy Residency training program annually.
“ASPs are great for patients, optimal for public health and beneficial in reducing hospital costs and lengths of stay,” said Nicole Nicolsen, the manager of infectious diseases pharmacy and the ASP.
While ASPs are now required for all hospitals, ECU Health’s program is unique in that it has been in place for 30 years, well before most hospitals nationwide incorporated antimicrobial stewardship. Its innovative service of the ECU Health community hospitals through remote/tele-stewardship sets the program apart and increases care in rural communities.
“Our program is empowered by the Medical Executive Committee (MEC) to make changes to antimicrobials” Nicolsen said. “Leadership support is not always as evident or official in other health systems, and this support shows ECU Health’s executive commitment to optimal antimicrobial use.”
Two recent ASP projects include a Board Quality Leadership Award (BQLA) submission, which evaluates interventions required for patients started on restricted antimicrobials and assesses ECU Health’s compliance with the current antimicrobial restriction criteria, and a QI Symposium project, which evaluated ECU Health’s response time to rapid technology used for blood cultures and confirmed appropriate drug recommendations for these results.
The program also has ongoing quality and research projects, including current enrollment in Teachers of Quality Academy (TQA) 9.0 collaborating with emergency medicine (EM) colleagues on optimal antimicrobial choice in the setting of a possible penicillin allergy.
Other project topics include development of an ECU Health clinical guideline for EM use of dalbavancin to spare hospital admission for skin and soft tissue infections and looking at drug choice/dosing strategies that may impact clinical outcomes in the grey areas of infectious diseases. The team continues to ensure compliance with the Joint Commission standard related to ASPs, reviews medication safety events related to antimicrobials, identifies and implements cost saving initiatives and maintains site visits to all ECU Health community hospitals to develop relationships and improve the understanding of the value of ASPs.
The ASP’s efforts to anticipate and address the ongoing concerns regarding antimicrobial resistance are something Nicole said would not be possible without great team members who publish papers in major medical journals and participate in ECU Health, regional and national conferences and committees.
“Excellence in antimicrobial stewardship isn’t accidental; it’s built by an exceptional team,” said Nicolsen. “What sets this team apart is not just how much they have accomplished, but how they do it with expertise, collaboration and unwavering commitment to always go above and beyond. Their work optimizes patient outcomes today, preserves antimicrobial utility for tomorrow and firmly positions our system at the forefront of infectious diseases pharmacy and ASPs.”