Children's Hospital Colorado Measures How Antibiotics are Prescribed to Patients in Hospitals Across Colorado

The pediatric hospital's Antimicrobial Stewardship Program is nationally recognized for playing an important role in optimizing the use of antibiotics for better patient and hospital outcomes

AURORA, Colo., Sept. 7, 2022 /PRNewswire/ -- Children's Hospital Colorado (Children's Colorado) announced today a Colorado collaboration on antimicrobial stewardship and best practices for hospitals to improve the optimization and use of antibiotics leading to better pediatric patient outcomes.

Daniel Dodson, MS, MD, lead researcher and assistant professor at UC Davis Medical Center, under the leadership of Sarah Parker, MD, infectious disease specialist at Children's Colorado, partnered with the Colorado Department of Public Health and Environment (CDPHE) to review stewardship implementation in adult and pediatric, urban and rural hospitals across Colorado. The goal of this survey was to identify best practices, share resources and bridge gaps in various understandings of antimicrobial stewardship for various age groups and care plans.

"Antimicrobial resistance is a big problem in the United States. Unnecessary antibiotics may sound harmless, but they are not. They carry many different types of risks for individuals and populations," said Dr. Dodson. "By implementing best practices for an antimicrobial stewardship program in hospitals, we will be able to coordinate and promote the appropriate use of antibiotics to improve pediatric patient outcomes, reduce microbial resistance and decrease the spread of infections caused by multidrug-resistant organisms." 

Of the 100 surveys sent to hospitals, 41 responded about their stewardship program implementation. The survey inquired about core elements of an antimicrobial stewardship program such as leadership, commitment, accountability, drug expertise, actions to improve antibiotic use, tracking, reporting and education. Drs. Dodson and Parker followed up with survey respondents and conducted individual interviews to learn more about best practices, challenges and barriers to implementing a stewardship program.

"80% of hospitals met stewardship standards, but they weren't consistently implementing best methods of stewardship and communicating how to improve antibiotic prescribing to combat antibiotic resistance," Dr. Dodson said. "There is no 'one size fits all' approach to optimize antibiotic use for all settings. The complexity of medical decision-making surrounding antibiotic use and the variability in facility size and types of care require flexible programs and activities. Hospitals that have antimicrobial stewardship programs help providers understand if a patient should be on an antibiotic by asking a few simple questions such as – is this the right drug, right dose, right duration?"

Previous work through the Children's Colorado stewardship team found that when a best-practice "handshake" antimicrobial stewardship program is in place, it can do the following:

• Save an average of $2 million each year in prescription drug costs
• Identify whole system-wide issues (noticing when surgeons are all prescribing one antibiotic, etc.) 
• Significantly change a patient's care when stewards have identified opportunities for a medicine/prescription change 
• Inform the entire team – nurses, other team members – so everyone can advocate for a patient's care plan 

"Implementing a pediatric-focused antimicrobial stewardship program is critical because of the differences in antimicrobial need and use among a pediatric population, vulnerability for resistance due to a longer period of antibiotic exposure and increased risk of adverse events," said Dr. Parker. "It's so important to implement 'handshake stewardship' to establish strong communication of interventions in person between a pharmacist, physician team, care team and family being cared for. Context is everything and discussing the nuances of a child's antibiotics plan will only set them up for success while developing into adults, where conversations of antibiotics use should be ongoing."

"We have a mission to support antibiotic stewardship across the healthcare system. This partnership with Children's Hospital Colorado has allowed us to quantify resource needs in Colorado community hospitals. We are excited to now draw upon the expertise of the antibiotic stewards at Children's Colorado to mentor newer antibiotic stewardship programs and to broadly support evidence-based activities to improve antibiotic use," said Chris Czaja, MD, DrPH, Medical Epidemiologist and Healthcare Associated Infections & Antimicrobial Resistance Program Manager, CDPHE.

In 2014 the Center for Disease Control and Prevention (CDC) provided antimicrobial guidelines and standards from key healthcare partner organizations, including the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, American Society of Health System Pharmacists, Society of Infectious Diseases Pharmacists and The Joint Commission. These were updated in 2019. The CDC has been tracking antimicrobial stewardship programs and has found these programs are up 85%, though this update may not necessarily reflect best practices. Results suggest that when looking at best practices, uptake falls to 40%, and in pediatrics, it is only 14-17%. Major barriers to improved stewardship are available time and ability to gather data from medical records. 

"We examined core elements of an antimicrobial stewardship program and found a critical need to implement community-wide efforts, especially in pediatrics," Dr. Dodson said. "There is an opportunity for Children's Colorado to help educate pharmacists to review antibiotics being prescribed to make sure they are correct for treating pediatric patients."

Under Dr. Parker's leadership, the Children's Colorado Handshake Stewardship program team has published key benefits to the program, including the acceptance rate, the cost savings and the sustainability of the model, making it easier for community hospitals to implement. To learn more about antimicrobial stewardship in primary care, visit this link to listen to Dr. Parker in S4:E9 of Charting Pediatrics. To learn more about the use of antibiotics, visit childrenscolorado.org.

To implement a best practice antimicrobial stewardship, please utilize the resources on the CDPHE website, found here.

Children's Hospital Colorado is one of the nation's leading and most expansive nonprofit pediatric healthcare systems with a mission to improve the health of children through patient care, education, research and advocacy. Founded in 1908 and recognized as a top 10 children's hospital by U.S. News & World Report, Children's Colorado has established itself as a pioneer in the discovery of innovative and groundbreaking treatments that are shaping the future of pediatric healthcare worldwide. Children's Colorado offers a full spectrum of family-centered care at its urgent, emergency and specialty care locations throughout Colorado, including an academic medical center on the Anschutz Medical Campus in Aurora, hospitals in Colorado Springs, Highlands Ranch and Broomfield, and outreach clinics across the region. For more information, visit www.childrenscolorado.org or connect with us on Facebook, Twitter, Instagram and YouTube.  

Children's Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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Sarah Davis
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SOURCE Children's Hospital Colorado