Antibiotic Stewardship Drivers and Change Package
A Framework to Reduce Inappropriate Antibiotic Utilization in Hospitals
The Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers for reducing inappropriate antibiotic utilization. Content experts contributed to the development of this robust driver diagram and change package with a recognition and emphasis on practicality and ease of implementation in all hospitals.
“A driver diagram is a tool to help organize our theories and ideas in an improvement effort as we answer what change can we make that will result in improvement? The initial driver diagram for an improvement project might describe the descriptive theory of improved outcomes that can then be tested and enhanced to develop a predictive theory. The driver diagram should be updated throughout an improvement effort and used to track progress in theory building(1)”.
From September 2011 to June 2012, CDC and IHI worked with eight hospitals on pilot testing the enclosed set of recommendations to assess the feasibility of implementation in hospitals of varying size, acuity, and location. The Driver Diagram and Change Package were modified based on that pilot testing.
How to Use The Driver Diagram and Change Package:
The Driver Diagram attempts to lay out the various processes that can lead to optimal antibiotic use. The broad categories of these processes are referred to as Primary and Secondary Drivers. The Change Package outlines a number of specific interventions that have either been demonstrated to or experts believe will positively impact the drivers. The ultimate goal is to use the interventions in the Change Package to “drive” improved antibiotic use.
We do not recommend that any facilty attempt to implement all of the interventions at once.
There are a large number of interventions outlined in the Change Package, and attempting to implement too many at one time will likely create huge challenges. Rather, the Change Package is meant to serve as a menu of options from which facilities can select specific inerventions to improve antibiotic use.
Selection of specific interventions to implement should be tailored to the areas that most need improvement at each facility.
Facilities should assemble a multi-disciplinary team of physicians, pharmacists, nursing, microbiology and administration to discuss the aspects of antibiotic use that are most in need of improvement. The team can then select specific interventions from the Change Package to address those issues. It is important to select the interventions that are most supported by clinical staff.
It is essential to monitor and measure.
The Driver Diagram and Change Package come with a Measurement Framework, which suggests various measures of antibiotic use that might be useful to assess the effectiveness of improvements. Just as important is the measurement of “small tests of change” to assess the implementation of interventions. Reviews of small numbers of charts or discussions with clinicians can identify potential barriers to implementation.
We would love to hear your thoughts and input.
The Diver Diagram and Change Package are living documents that should continue to be refined as we gain more experience with implementation and more data on how to improve antibiotic use. CDC welcomes your suggestions for ways we can improve these documents. Please let us know if you discover barriers to implementing interventions, ways to overcome barriers or other interventions that prove effective in your facility. We would also welcome suggestions you have for ways that you were able to monitor improvements in antibiotic use. Please feel free to submit comments to: firstname.lastname@example.org
- Refers to: The Improvement Guide— A Practical Approach to Enhancing Organizational Performance (2nd Edition). Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. San Francisco, California, USA: Jossey-Bass Publishers; 2009.