Antimicrobial Stewardship Program is a coordinated therapy formulated to determine the best selection of antibacterial drugs that can be prescribed to a patient. The given therapy includes a pattern to offer a treatment, which does not only involve drug prescription, but also explains how it is administered. It shows the duration and routine to be followed. The given paper looks at the Antimicrobial Stewardship Program implemented at a rural hospital in Louisiana of less than 100 bed capacity. It highlights the advantages and limitations of the strategies used in the program implementation.

The Antimicrobial Stewardship Program (ASP) described in this paper used telemedicine technology due to the lack of sufficient medical staff in the hospital. The hospital was inadequately staffed with the infectious diseases (ID) specialist as well as a pharmacist with advanced training in the infectious diseases. The ASP was to be implemented through a multidisciplinary team that was assembled and received directions via teleconferencing from the remotely located ID physician. The program took effect for 13 months (May 2010- June 2011) with a review of the therapy taking effect after every 3 days a week. There was an increased intervention from the pharmacist from a baseline of 2.1 a week to 6.8 per week. The rate of streamlining increased from 44% to 96% on average. The program implementation led to a decrease in antibiotic costs, while there was a decrease in the rate of Clostridium Difficile infection from an average of 5.5 cases per 10000 patient days to 1.6 cases per 10000 patient days (Yam et al., 2012).

There are strategies that successfully implement the ASP programs. They include prospective audit with direct intervention and feedback.  This strategy involves evaluating the suitability of the orders for antimicrobial agents and recommending alternatives. Responses to the prescribers may be oral or written. It is widely used in the practice setting with a limited frequency of interventions. The advantages of this evaluation strategy are high chances of reducing the use of unsuitable antimicrobial agents. This is because of the periodic audits and interventions carried out in the implementation of the program. It serves well in educational settings to modify future prescribing. In addition, it allows the prescribers to maintain autonomy. The main disadvantage of prospective audit with direct intervention and feedback is difficulty in recognizing patients with an inappropriate therapy, as well as communicating with the prescribers (Ohl & Dodds, 2011).  

The second evaluation strategy is known as a formulary restriction and pre authorization requirements. It involves limiting the use of specific antimicrobials agents, therapy duration, physician services, and population of the patients and prescribers. Restriction depends on the levels of antimicrobial resistance and patient safety issues. It is commonly used for the educational purposes in some institutions. Another advantage is immediate and significant reductions in the antimicrobial use and costs. The disadvantages are increased staff requirements involved in implementing this strategy. There is a bureaucracy in authorization, and delays may occur concerning the detriment of the patients’ outcome. This strategy deprives the autonomy of a patient and may result in resistance to certain antimicrobial agents (Ohl & Dodds, 2011). 

In case of the rural hospital, the use of prospective audit with direct intervention and feedback evaluation strategy was used in combination with a streamlining in the antimicrobial exposure. This strategy had a successful scenario of application. The ASP therapy revealed that for a successful implementation of this program the pharmacists’ intervention has to be increased (Garst & Heinze, 2011).

The ASP should be used sparingly and with caution to different patients and institutions depending on their rules. The therapy is useful in treating patients from different fronts and not only with the help of drugs. The ASP should be accepted throughout the health facilities and utilized in the extremely careful manner.

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