St. Francis Medical Center’s Antimicrobial Stewardship Program

St. Francis Medical Center is committed to the appropriate use of antibiotics to reduce the emergence of antibiotic-resistant organisms. St. Francis Medical Center (SFMC) took a proactive approach in establishing an Antimicrobial Stewardship Program (ASP) in May 2011, three years prior to when the program was mandated by the State of California in September 2014. The hospital’s antimicrobial stewardship initiative was a direct reflection of the commitment of the senior management and the Pharmacy leadership team to improving patient care and outcomes.

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ASP History

Antimicrobial stewardship programs (ASPs) were initially implemented in the 1990s to address the growing threat of antibiotic resistance and to improve patient outcomes by optimizing antibiotic use. California was the first state to pass legislation requiring hospitals to implement these programs, mandating that they monitor the judicious use of antibiotics to minimize adverse events like Clostridioides difficile infections and reduce the emergence of resistant organisms. A 2008 California law required that general acute care hospitals develop a process for monitoring the judicious use of antibiotics and that the results be monitored by quality improvement committee(s). In September 2014, California Senate Bill 1311 was signed into law, further requiring hospitals to adopt and implement an antimicrobial stewardship policy in accordance with guidelines established by federal government and professional organizations, and to establish a physician-supervised multidisciplinary antimicrobial stewardship committee with at least one physician or pharmacist who has undergone specific training related to stewardship.

Concurrently, a presidential Executive Order – Combatting Antibiotic-Resistant Bacteria – was issued nationally. It required federal agencies to review existing regulations and propose new regulations or other actions to require hospitals to implement robust stewardship programs that adhere to best practices.

The Foundation of SFMC’s ASP

The hospital’s ASP was built on 1) Continuous leadership support through the commitment of required resources including a dedicated pharmacist and an infectious disease physician champion; 2) Passion to decrease Clostridium difficile infections and the emergence of antimicrobial resistant organisms; and 3) Tireless, ongoing hard work of collaborating physicians and staff across all disciplines.

Early on the hospital’s ASP processes comprised 1) The ASP team holding table-rounds three times a week to discuss cases and make recommendations to physicians on antibiotic usage; 2) Presentations made regularly to the medical staff to provide quarterly dashboards and updates on antibiotic usage patterns; 3) Information widely shared with Infection Prevention Control Committee, Antimicrobial Surge Committee, QA-I Committee, Pharmacy and Therapeutics, and others; and 4) Monitoring data in C-diff rates.

Today we continue the commitment to maintaining a strong antimicrobial stewardship program with dedicated team members that include the infectious disease physicians, clinical pharmacists, chief nursing officer, Infection Control, Quality, and Microbiology/Laboratory. The ASP Committee meets regularly to discuss antibiotic usage and resistance trends to educate the hospital team about resistant patterns and best practices to follow in the global effort to ensure effective antibiotics remain available for future generations to come.

Statement of Leadership Commitment for Antibiotic Stewardship

St. Francis Medical Center commits to improving antibiotic use in our facility. Facility leadership is committed to embracing and executing the Centers for Disease Control & Prevention’s (CDC) Core Elements of Antibiotic Stewardship for Hospitals. The seven core elements for antimicrobial stewardship include leadership, commitment, accountability, drug expertise, action, tracking, reporting, and education.

Our administration has identified an Antimicrobial Stewardship Program (ASP) Leadership Team at our facility. Our leadership team meets at least quarterly and they are:

Our ASP physician champion
Our ASP pharmacy champion
Our ASP infection prevention champion
Our ASP microbiology/laboratory champion
Our ASP information technology champion

A St. Francis Medical Center clinical pharmacist serves as the designated lead for the Antimicrobial Stewardship Program, who works in collaboration with an infectious disease physician.

STATEMENT OF COMMITMENT

We, the administration, are committed to supporting the efforts that improve antibiotic use in our facility, including providing dedicated necessary human, financial, and information technology resources. (Leadership Commitment Core Element)
We have appointed co-leaders, an infectious disease physician and clinical pharmacist, to be responsible for program management and outcomes. (Accountability Core Element)
We have appointed a pharmacist, co-leader of the stewardship program, to lead implementation efforts to improve antibiotic use. (Pharmacy Expertise Core Element)
We will support implementation of interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use. (Action Core Element)
We will work with our ASP leaders and team to create a system that monitors antibiotic prescribing, impact of interventions, and other important outcomes like Clostridioides difficile infection and resistance patterns. (Tracking Core Element)
We will create an environment that allows the antimicrobial stewardship team to regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership. (Reporting Core Element)
We commit to creating a culture for education which promotes antimicrobial stewardship through education of prescribers, pharmacists, and nurses about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing. (Education Core Element)

CNO, Executive Administration
Leadership Administrator
St. Francis Medical Center

Clinical Pharmacist
ASP Champion
St. Francis Medical Center

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ASP Honor Roll

St. Francis Medical Center has continued to maintain a robust antimicrobial stewardship program. This is evidenced by SFMC being named to the California Department of Public Health’s Bronze Honor Roll in 2023, for meeting at least one criterion from each of the Centers of Disease Control & Prevention’s seven core elements of a successful antimicrobial stewardship program. The designation recognizes the hospital’s foundational commitment to optimize appropriate antibiotic use and prevent antimicrobial resistance.

Antibiotic Stewardship Mission Statement

St. Francis Medical Center maintains antimicrobial stewardship as one of its priorities. Its ASP mission encompasses the following goals:

To practice the CDC’s 7 core elements of a successful antimicrobial program –
- Leadership commitment
- Accountability
- Pharmacy expertise
- Action
- Tracking
- Reporting
- Education
To optimize the treatment of infections while minimizing adverse effects.
To collaborate with multidisciplinary teams across the hospital, including infectious disease physicians, Pharmacy, Infection Control, and Microbiology/Laboratory.
To reduce the emergence of antibiotic resistance that can result from misuse, overuse, or inappropriate prescribing, and to decrease C. difficile infection rates.

Improved Care and Outcomes

Ultimately, St. Francis Medical Center’s commitment to antimicrobial stewardship supports improved patient care and public health. With a strong antimicrobial stewardship program in place, the hospital continues to combat the health threat of antibiotic resistance; promote the appropriate selection, dose, and duration of antibiotics for better clinical outcomes; reduce complications resulting from unnecessary or inappropriate prescribing of antibiotic; and lower overall healthcare costs.