Healthcare Inspection – Review of Antimicrobial Stewardship Programs in VHA Facilities

As directed by the Senate Appropriations Committee report to accompany H.R. 2029, Military Construction, Veterans Affairs, and Related Agencies Appropriation Bill 2016, and at the request of Senator Dianne Feinstein, the Office of Inspector General (OIG) reviewed Veterans Health Administration (VHA) implementation of Antimicrobial Stewardship Programs (ASPs). The majority of VHA facilities had established ASPs; however, we identified variations with program implementation. A large majority of facilities had written policies and designated ASP champions; however, over one third did not timely complete program evaluation, and facilities reported less than 50 percent compliance with staff education on appropriate use of antibiotics. VHA made efforts to collect and analyze data on antibiotic use and resistance but did not endorse one standard data collection tool for inter-facility comparisons and consistency of data collection and reporting. Additionally, facilities did not consistently generate clinical outcome reports on antibiotic usage. Therefore, VHA cannot effectively measure positive or negative national trends on antibiotic use to guide improvement efforts. With standardization, individual facility and system-wide trends can be analyzed. Further, in order to achieve optimal ASPs, facility leaders need to provide dedicated staff, administrative support, and essential tools to develop and maintain such programs. OIG recommended that the Under Secretary for Health: Implement procedures to ensure that facilities comply with VHA Directive 1031 requirements, including the completion of annual evaluations, designation of provider and pharmacy champions, staff education, and the provision of adequate dedicated staffing and resources; Require VHA facilities to track and generate clinical outcome reports on antibiotic use; Consider implementing standardized tools and definitions for antimicrobial stewardship data and a uniform reporting system to permit analysis of comparable information over time.