Georgia Honor Roll for Antibiotic
Stewardship
The Georgia Healthcare Associated Infections Advisory Committee, representing a broad
partnership of stakeholders in the state, invites you to engage in antibiotic stewardship and
to be recognized for your efforts publicly.
Facilities that apply will be recognized by this state partnership for their commitment, listed
on an Honor Roll web site, and receive a certificate of recognition. In addition, the state
partnership will provide resources and technical support to assist facilities in engaging in
antibiotic stewardship.
There are three requirements for Phase I of this project: (1) Letter of Commitment from
Leadership, (2) Identification of an Antibiotic Stewardship Team, and (3) an Educational
Event. A second phase (Implementation) is also available for those healthcare facilities
which have completed Phase I.
Phase I: Engagement















Item 1: Letter of Commitment from Leadership to Georgia Antibiotic Stewardship
Subcommittee
Requirements:
A statement of commitment of the facility to engage in antibiotic stewardship
An educational event (see Item 3)
Request to report progress back to the facility executive board in one year
Signature of CEO/CMO and board member
Item 2: Identification of Antibiotic Stewardship Team
Requirements:
List at least four members of your antibiotic stewardship team and their roles
The stewardship team needs to include a physician champion and a clinical
pharmacist. The remaining members of your team will depend upon your facility
personnel and resources. Members may include physicians, pharmacists, infection
preventionists, patient advocates, administrators, information technology, quality,
etc. Stewardship efforts benefit greatly from infectious disease expertise. The physician
champion and a clinical pharmacist, however, do not need to have advanced training in
infectious diseases to lead the facilities efforts to improve antibiotic prescribing.
Team must meet at least quarterly during a 12 month period
A role of the team is to plan a staff educational event on antibiotic stewardship; additional
activities may be conducted as well
Resources:
SHEA Antimicrobial Stewardship Team Proposal
Item 3: Educational Event
Requirements:
Conduct at least one staff educational event during a 12-month period. The educational
event must be summarized in the executive letter (see Item 1).
The purpose of the educational event is to inform facility staff regarding the need for
antibiotic stewardship and practices. The educational event should identify a target
audience at the facility for the training (e.g., hospitalists, pharmacists, physicians,
physician assistants, etc.).
Sample educational events include:
Conducting an in-service on core concepts of antibiotic use
Instructing staff on educating patients on antibiotic stewardship efforts at your facility
Integrating/updating antibiotic stewardship practice into medical school curriculum
Integrating antibiotic stewardship training in new employee orientation
Resources:
Centers for Disease Control and Prevention CE Program: Get Smart: Continuing Education
and Training
Training on Measurement of Antibiotic Stewardship
Wake Forest School of Medicine: An Antibiotic Stewardship Curriculum for Medical Students
Phase II: Implementation











All hospitals that meet Phase I will be included on the honor roll and receive a
certificate. We recognize there may be a few hospitals that are implementing and
measuring antibiotic stewardship activities and completing the requirements below. For
those hospitals that meet these requirements, they are welcome to apply for Phase II
(implementation). For those that meet the Phase II requirements, a symbol will be added
next to their facility name to indicate these additional activities.
Item 4: Antibiotic Stewardship Programs
Requirements:
Facility must demonstrate that it is actively engaged in antibiotic stewardship activities
that are outside of evaluating formulary and pharmacy costs
Facility must demonstrate that it has undergone a process to select appropriate
stewardship activities according to its needs and resources. This process may be a gap
analysis, part of a risk assessment, or other evaluation conducted by antibiotic
stewardship team. Evidence of these activities includes submission of gap analysis or risk
assessment worksheet or antibiotic stewardship team meeting minutes documenting this
evaluation
Sample activities include:
Defined formulary of antimicrobial agents and prescribing restricted to those agents on
formulary
Hospital requires pre-authorization or approval of selected antimicrobials by infectious
disease physician, pharmacist, or other staff member
Review or audit of selected antimicrobials on a daily or weekly basis by infectious disease
physician, pharmacist, or other hospital staff member
Results of audits/reviews of antimicrobial use are provided directly to prescribers, through
in-person, telephone, or electronic communications
Automatic stop orders (e.g., after 2-3 days, subject to documentation of the need for
ongoing therapy) are in place for selected antimicrobials
Prospective clinical audit and prescriber feedback, using a tool similar to that provided in
the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI; see resources)
Resources:
A Hospital Pharmacist's Guide to Antimicrobial Stewardship Programs
APIC Toolkit
IHI Driver Diagram and Change Package
Joint Commission Standards for Antibiotic Stewardship
New York State Toolkit
SHEA/IDSA Guidelines
Strategy for the Control of Antimicrobial Resistance in Ireland
Item 5: Measurement of Antibiotic Stewardship Program
Requirements:
Facility demonstrates that it is measuring the impact of antibiotic stewardship activities
noted under Item 4.
The measurement activities must be directly related to the antimicrobial stewardship
activity and not a measure that is collected for another purpose and may be tangentially
related to stewardship (e.g., the measurement of Lab ID Clostridium difficile infection
(CDI) is required for most hospitals by CMS. By itself, Lab ID CDI is not a measurement
of an antibiotic stewardship program)









Sample measurement activities include:
Antimicrobial consumption hospital wide or per unit.
Plan-Do-Check-Act (PDSA) cycles for selected record reviews for antibiotic use
improvement projects:
Patients where cultures are reviewed before first antibiotic dose.
Patients where antibiotic start date is documented.
Patients with a documented antibiotic stop date
Measurement activities may include the use of existing information systems, such as a
laboratory data mining system that provides information regarding IV and PO utilization
rates and usage of selected agents.
Measurement of consumption as defined daily dose, using WHO methodology
http://www.whocc.no/ddd/definition_and_general_considera/.
Use of the NHSN Antimicrobial Use and Resistance
Module http://www.cdc.gov/nhsn/acute-care-hospital/aur/.