Implementation of an antimicrobial stewardship program in a multicenter neonatal intensive care unit collaborative: a mixed-methods staff resource needs evaluation

OBJECTIVE: Staffing needs for an antimicrobial stewardship program (ASP) in the neonatal intensive care unit setting are undefined. STUDY DESIGN: In an ASP collaborative of 29 California NICUs, we surveyed sites to determine full-time equivalents (FTE) for ASP implementation effort by clinical role, clinical acuity, patient volume, and other NICU characteristics. RESULTS: 146 staff members performed ASP implementation, including neonatologists, nurses, hospitalists, nurse practitioners, pharmacists, information technology personnel, and infectious disease specialists. The 8-month preparation and 12-month intervention phases required a median (IQR) of 0.015 (0.011-0.025) and 0.071 (0.056-0.091) FTEs (0.6 and 2.8 hours per week), respectively. Neonatologists and nurses performed 43% and 19% of the workload, respectively; effort for site-level stewardship activities and collaborative learning dissemination varied 3.3-fold over the collaborative. Higher clinical acuity and patient volume were associated with higher neonatologist effort. CONCLUSION: Driven by neonatologists and nurses, NICU ASP requires demonstrable effort, and staff needs vary considerably.