Antibiotic Reporting Systems Help Pinpoint High Use ‘Hot Spots’

Data collection is crucial to helping health care stakeholders—including medical providers and public health experts—evaluate antibiotic prescribing practices, ensure their appropriate use, and slow the emergence of deadly antibiotic-resistant pathogens, or “superbugs.”

The Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) gathers data on a range of health care-associated infections that patients acquire during hospitalization, long-term care facility stays, outpatient surgery center visits, or medical procedures such as dialysis.

This surveillance system also collects data specific to antibiotic-resistant infections and antibiotic prescribing from inpatient facilities through the Antimicrobial Use and Resistance (AUR) Module—allowing these facilities to better understand their prescribing practices and improve antibiotic stewardship efforts—with the goal of reducing antibiotic-resistant infections.

This interview with Kelley Garner, manager of the Healthcare-Associated Infections Program at the Arkansas Department of Health, and Jordan Murdoch, who is the stewardship pharmacist for the department, is one in a Pew series of interviews with five state health department officials to learn about antibiotic stewardship efforts to encourage data reporting. This interview has been edited for clarity and length.

Q: Can you tell us about your work in Arkansas?

Garner: I oversee the Arkansas Department of Health’s activities related to healthcare-associated infections, including making sure that we meet deliverables for the grants we receive through CDC. I also oversee the department’s overall strategy for improving antibiotic stewardship efforts.

Murdoch: And I implement Kelly’s vision and direction with on-site visits to facilities in Arkansas. I use something called a statewide antimicrobial stewardship initiative (SASI) tool during these visits, which gives me a framework to assess a facility’s current antibiotic stewardship program, provide feedback, and give an opportunity for on-site stewardship leaders to reflect on their program.

Q: What did your antibiotic stewardship work look like initially in Arkansas?

Garner: Before I started in 2013, the department held an antibiotic stewardship summit with a wide range of stakeholders, such as prescribers, pharmacists, and public health experts. Some of those folks asked if the state health department could lead antibiotic stewardship coordination efforts across the state. People felt that if the department took that on, there would be a more consistent and reliable effort to collect and monitor antibiotic data.

Murdoch: I think the confidence in the Department of Health to lead those efforts speaks to the department’s stability and our ability to recognize the differences between health care facilities. Facilities often vary greatly in their resources and their patient populations, and at the department we have better visibility into those differences than some other stakeholders might.

Q: How did the stewardship program get started?

Garner: Our program received dedicated funding for antibiotic resistance and stewardship work in 2016, but even before that, we partnered with outside stakeholders to create a pharmacy-led antibiotic stewardship collaborative.

One of the early things we did was identify health care facilities that had the same electronic health record systems and get those folks connected to each other so they could learn more about creating effective data reports. That was useful because the pharmacists could create antibiotic prescribing reports and share them with prescribers to create awareness and momentum for stewardship. At the time, we had no money, and the CDC’s National Healthcare Safety Network Antimicrobial Use and Resistance (AUR) Module wasn’t available to health care facilities yet.

We also made our IT folks available to help. We’d say, “Our IT folks can run this report, we’ll share how they did that, maybe your guys can run the same report.” That actually made a big impact because it gave facilities access to new data, so they could draw comparisons between their antibiotic use and prescribing rates at other facilities at a very low cost.

Q: Does the AUR Module make it easier to draw comparisons between facilities?

Garner: Yes. We’re trying to get folks to use AUR so their data is standardized. The data can be adjusted within the module to take into account differences in patient populations between facilities; for example, larger hospitals or those connected to universities are more likely to have units for oncology patients and premature newborns, whereas smaller hospitals don’t always have capacity to treat these types of patients. The module makes it easier to compare prescribing data across different facilities.

Murdoch: It’s hard for hospitals to adjust this data by themselves because they don’t have a way to benchmark their antibiotic prescribing patterns with hospitals outside of their health network. For example, it’s hard for hospitals to know how many antibiotics in an ICU are normal for a hospital of similar size. The AUR Module helps create a context, so facilities have more awareness into their own rates of prescribing. And it also allows the Department of Health and individual prescribers to see if rates of prescribing are universal across our whole state, or if there are “hot spots” in certain areas.

Q: So, what challenges do hospitals face when trying to use the AUR Module?

Garner: It’s very expensive for hospitals to set up a new reporting system. And a lot of their IT folks are spread pretty thin. In 2016, we were able to give out six $30,000 stipends to help hospitals report their data into the AUR Module. At the time everyone was like, “That’s so much money!” But I think now that people understand how expensive it is for surveillance systems to be integrated, it doesn’t seem like a lot.

Q: What advice would you give to other states to help increase reporting?

Garner: Try to find out and understand what facilities are using from a reporting standpoint, so you can help them work with the resources they have. We always support facilities reporting into the National Healthcare Safety Network, which is really the gold standard because it provides a great framework to draw comparisons—but not all facilities have access to NHSN or the AUR Module.

Murdoch: It’s helpful to set up focus groups to understand what reporting systems facilities have access to and how they’re using them. And once you know that, you can figure out the best way to work with a facility’s IT team to increase reporting from that point. We’ve found that setting up peer-to-peer partnerships to connect one facility with another similar one has increased reporting successfully.