course material

1. Antibiotic Stewardship in Inpatient Settings Quality Improvement
Proposal
Antibiotic Stewardship in Inpatient Settings Quality Improvement Proposal.Antibiotic
Stewardship in Inpatient Settings Quality Improvement Proposal. 3 reference articles
included in files In a 1000 word paper, describe the problem or issue and propose a quality
improvement initiative based on evidence-based practice, incorporate one of the following
strategies : PDSA cycle, FADE, lean strategy, and Six Sigma in quality improvement in
patient care related to this subject- antibiotic stewardship (pharmacists assistance)ORDER
A PLAGIARISM-FREE PAPER HEREInclude the following: 1. Provide an overview of the
problem and the setting in which the problem or issue occurs. 2. Explain why a quality
improvement initiative is needed in this area and the expected outcome. 3. Discuss how the
results of previous research demonstrate support for the quality improvement initiative
and its projected outcomes. Include a minimum of three peer-reviewed sources published
within the last 5 years, not included in the course materials or textbook, that establish
evidence in support of the quality improvement proposed. 4. Discuss steps necessary to
implement the quality improvement initiative. Provide evidence and rationale to support
your answer. 5. Explain how the quality improvement initiative will be evaluated to
determine whether there was improvement. 6. Support your explanation by identifying the
variables, hypothesis test, and statistical test that you would need to prove that the quality
improvement initiative succeeded. While APA style is not required for the body of this
assignment, solid academic writing is expected, and documentation of sources should be
presented using APA formatting guidelines, which can be found in the APA Style Guide,
located in the Student Success CenterFacing the Problem of Antibiotic Resistance: Bettering
Antimicrobial Stewardship (AMS) Efforts and the Antimicrobial Use Process (AUP)The
problem of antibiotic resistance is a major issue in the treatment of infectious diseases in
the hospital setting. Drug resistance is a serious life and death issue. This is especially true
for antibiotics. When a patient develops bacteria that are resistant to antibiotics, they will
not benefit from the said antibiotics the next time they are treated with them. The result is
that they may die from their infection if a stronger and more superior alternative is not
instituted in time. To make matters worse, the resistant patient may infect other patients or
persons with this resistant strain of bacteria and hence transfer the same problem to them.
With the passage of time, the public health authorities may find themselves with a big public
health menace of widespread antibiotic resistance causing initially preventable mortalities.

2. This is the problem, and it usually occurs disproportionately in the inpatient hospital
setting. According to the Centres for Disease Control and Prevention (CDC), an
overwhelming half of all the antibiotics that are prescribed and administered to patients in
the United States are either inappropriate or unnecessary (The PEW Charitable Trust,
n.d.).In fact, over 2 million patients annually acquire antibiotic-resistant microbes in the US.
This alone has been linked to about 23,000 mortalities annually. In this, what is important
to note is that virtually all use of antibiotics in any healthcare setting can lead to the spread
of resistant strains of bacteria (The PEW Charitable Trust, n.d.).Because of the problem
above, a quality improvement initiative is necessary in all health facilities in order to keep in
check and prevent actions by health workers and clinicians that could aid the spread of
antibiotic resistance. One of the hlobal organizations that has for some time beeen raising
awareness about this very serious problem in the healthcare system is the World Health
Organisation ir WHO (Bashir & Gray, 2017). This is because the problem has been with us
fir quite some time now, but little concerted effort have been directed at it by individual
health facilities. Part of the problem is the erroneous belief that antibiotic resistance is only
a problem in poor countries that still have a high prevalence of serious infections like
tuberculosis (TB). True, the problem of multi-drug resistant TB (MDR-TB) and extremely
drug resistant TB (XDR-TB) in these countries is well documented.Quality improvement
initiatives like antimicrobial stewardship (AMS) programs are therefore becoming a
mandatory requirement in all healthcare facilities to prevent the spread of antibiotic
resistance (Truong & Yamaki, 2018). These are also at times referred to as antibiotic
stewardship programs or ASPs (The PEW Charitable Trust, n.d.). The expected outcomes of
these are a reduction in circulating resistant strains of bacteria, and hence a reduction in the
number of deaths caused by nonresponse to antibiotics.Support for Quality Improvement
InitiativesTruong and Yamaki (2018),Bashir and Gray (2017), and the PEW Charitable Trust
(n.d.) have all pointed out the need for putting a stop to antibiotic resistance by instituting
appropriate measures. Truong and Yamaki (2018) propose that all health institutions
follow the antimicrobial use process (AUP) as part of their antibiotic stewardship programs
and initiatives. In this, they recommend adhering to the following seven steps in the AUP:
careful prescription by the clinician, verification by the pharmacist before dispensation,
correct and timely administration by the bedside nurses, monitoring efficacy by using
cultures after 48 hours, and finally a team approach to discharge prescribing during
transition of care to the home environment. On their part, The PEW Charitable Trust (n.d.)
opines that ASPs assist in inculcating the appropriate use of antibiotics, and that the CDC
has some crucial tools that can help healthcare institutions come up with effective ASPs.
These tools include the "Core Elements of Hospital Antibiotic Stewardship Programs" and
the "Core Elements of Antibiotic Stewardship for Nursing Homes." For Bashir and Gray
(2017), they aver that global efforts on sensitization of states and populations on the
importance of quality initiatives on this matter are invaluable.Steps For Implementing the
Quality Improvement InitiativesThe CDC has come up with the framework for
implementation of ASPs as quality improvement initiatives. The guidelines in this
framework suggest that healthcare institutions incorporate in their ASPs at least some of
seven crucial elements. These elements form the steps necessary for implementing ASPs.

3. They are: commitment by the facility leadership, making someone accountable for the
progress or failure of the ASP, incorporating drug expertise from a pharmacist in the ASP,
taking appropriate action when required, tracking progress, reporting progress and
drawbacks to stakeholders, and educating the human resource which includes clinicians
and nurses (CDC, 2019; The PEW Charitable Trust, n.d.). The rationale is that these steps
will provide the conceptual framework and direction to the ASP.Evaluation of the Quality
Improvement InitiativeAppropriate evaluation of any scientific process normally calls for a
data-driven approach. In order to assess the progress and success or otherwise of ASPs as
quality initiatives, the data on cultures showing resistant strains has to be compiled and
analysed. In this, rhe guiding hypothesis would be that there is a positive correlation
between inappropriate antibiotic use and the development of antibiotic-resistant strains of
bacteria. One of the statistical tools that can be used to test this hypothesis is the Chi-square
test of significance, and the variables would be antibiotic use and a positive blood culture
for resistant strains like Clostridium difficile. But before evaluation, the whole ASP initiative
should be guided by quality paradigms like Six Sigma. This means that defects (the
development of antibiotic-resistant bacteria, identified through blood culture) should never
be allowed (zero defects) or be reduced to the most minimum.Antibiotic Stewardship in
Inpatient Settings Quality Improvement Proposal