Implementing and Improving Stewardship Efforts

Antibiotic Stewardship Driver Diagram

Antibiotic Stewardship Driver Diagram and Drivers and Change Package is prepared by the Institute for Healthcare Improvement (IHI) and the Centers for Disease Control and Prevention (CDC)

[Download the Driver Diagram [PDF - 92 KB]]

Antibiotic Stewardship Driver Diagram

Timely and appropriate antibiotic utilization in the acute care setting

Decreased incidence of antibiotic-related adverse drug events (ADEs)
Decreased prevalence of antibiotic resistant healthcare-associated pathogens
Decreased incidence of healthcare-associated C. difficile infection
Decreased pharmacy cost for antibiotics

Primary and Secondary Drivers

1. Timely and appropriate initiation of antibiotics
   • Promptly identify patients who require antibiotics
   • Obtain cultures prior to starting antibiotics
   • Do not give antibiotics with overlapping activity or combinations not supported by evidence or guidelines
   • Determine and verify antibiotic allergies and tailor therapy accordingly
   • Consider local antibiotic susceptibility patterns in selecting therapy Start treatment promptly
   • Specify expected duration of therapy based on evidence and national and hospital guidelines
2. Appropriate administration and de-escalation
   • Make antibiotics patient is receiving and start dates visible at point of care
   • Give antibiotics at the right dose and interval
   • Stop or de-escalate therapy promptly based on the culture and sensitivity results
   • Reconcile and adjust antibiotics at all transitions and changes in patient’s condition
   • Monitor for toxicity reliably and adjust agent and dose promptly
3. Data monitoring, transparency, and stewardship infrastructure
   • Monitor, feedback, and make visible data regarding antibiotic utilization, antibiotic resistance, ADEs, C. difficile, cost, and adherence to the organization’s recommended culturing and prescribing practices
4. Availability of expertise at the point of care
   • Develop and make available expertise in antibiotic use
   • Ensure expertise is available at the point of care

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