• Innovation in Action

Jun 1, 2021

Antibiotic Stewardship Core Element 2: Accountability

Book about (AMS) Antimicrobial Stewardship isolated on wooden ta

Our previous post covered Antibiotic Stewardship Programs (ASP) featuring Core Element 1: Leadership Commitment. Today, we continue our focus on ASPs with Core Element 2: Accountability. As a refresher, the goal of ASPs is to provide every patient with the right antibiotics, at the right time, at the right dose, and for the right duration – to reduce adverse events and improve patient outcomes. In addition, ASPs also reduce C. difficile rates and antibiotic resistance. The Centers for Disease Control and Prevention (CDC) developed The Core Elements of Hospital Antibiotic Stewardship Programs, which outlines seven key components that have been successful.

Appointing leaders and co-leaders who are responsible for program outcomes provides accountability for antibiotic stewardship. ASP leaders should be accountable to the hospital leadership for meeting goals and targets. Published studies and guidelines have recommended physicians with training in infectious diseases as effective ASP leaders. In addition to expertise in antibiotic use and training in stewardship, leaders should also have leadership skills, respect from peers and good team skills.

Read through the accountability examples below to see if your organization is on the right track.

1 Medical staff and C-suite identify a physician and pharmacy leader with expertise in antibiotic use and training in stewardship responsible for leading the ASP. Physicians and pharmacists trained in infectious diseases have been shown to be effective.
2 Identify a nurse practitioner with expertise in antibiotic use if a physician or pharmacy leader are not available.
3 Ensure a collaborative approach between physicians and pharmacists.
1 Ensure the ASP leader has specific training in antibiotic stewardship (e.g., certification program or training course).
2 Hold the ASP leader accountable for specific stewardship outcome measures.
3 Include documentation of ASP outcome measures in performance evaluations.
4 Ensure the ASP leader actively engages other groups in stewardship efforts (e.g., EDs, hospitalists, surgeons, intensivists and nurses).
5 Ensure the ASP leader actively engages in any antibiotic related improvement efforts (e.g., peri-operative antibiotic use and early recognition and treatment of sepsis).
1 Tie established metrics to performance reviews and/or incentive payments for key leaders (e.g., appropriate antibiotic use and antibiotic timing for surgical prophylaxis and sepsis).
2 Consider hospital quality measures, such as Standardized Antibiotic Administration Ratio (SAAR) and C. difficile infection (CDI) rates as part of performance measures for ASP.
3 Engage Infection Preventionist in tracking antibiotic starts, monitoring adherence to evidence-based criteria during the management of infections, and reviewing antibiotic resistance patterns in the facility


Barriers to accountability could exist, such as an inability to find a qualified leader, leaders who are not effective stewards, fear of disciplining habitual offenders, lack of coordination with different disciplines or shifting priorities. The ASP can be prepared to deal with those challenges using some of the following solution ideas.

  • Support appropriate training for the designated leader
  • Contract with outside infectious disease physician or pharmacist groups, even part time or off-site
  • Create performance-based contracts to ensure leaders who are accountable
  • Establish a policy that defines noncompliance with the stewardship program recommendations and corrective actions
  • Ensure ASP leaders are well supported by facility leadership in efforts to address problem prescribers
  • Include ASP champions in all high-impact areas (e.g., critical care, surgery, primary care, ED and pediatrics)
  • Protect the time of the leaders responsible for ASP activities

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