Category: Professional Posters

Purpose: Small and critical access hospitals (CAHs) encounter unique challenges in implementing antibiotic stewardship (AS) often due to limited resources. The Joint Commission (TJC) requires AS within hospitals, including CAHs. In December 2016, a small and rural hospital antimicrobial stewardship alliance (SARAA) was established with the purpose of providing expert AS consultation and resources. Phase one of the program consisted of identification of regulatory gaps and implementation of strategies to enhance compliance with regulatory requirements. In phase two of this analysis, investigators sought to evaluate the presence of “low hanging fruit” pharmacist AS activities at small and CAHs.


Methods: This was a multi-site survey assessing the presence of antimicrobial stewardship initiatives related to intravenous to oral conversion, renal dosage adjustments, and dose optimizations within small and CAHs. Using a basic Likert scale [0=not present, 1=present, 2=partially present], antimicrobial stewardship activities were assessed for individual hospitals and the entire cohort.


Results: Twenty-eight hospitals with an average (+SD) daily census of 14 (+10.7) completed the survey. Less than 50% of hospitals reported the presence of an IV to PO conversion program (38%), renal dosing program (48%), or cefepime and meropenem dose optimizations (14% and 17%, respectively). The top two opportunities identified were dose optimizations for cefepime and meropenem to which hospitals replied “not present” 83% and 69% of the time, respectively. A vancomycin and aminoglycoside dosing protocol or guideline were present in 76% and 72% of hospitals, respectively.


Conclusion: This standardized survey identified “low hanging fruit” antimicrobial stewardship actionable initiatives for implementation in small and CAHs. Next steps to further the programs include a phased approach to implement these initiatives within all 28 hospitals.