Society for Healthcare Epidemiology of America Outlines Legal Considerations for Antibiotic Stewardship

Guide Addresses Concerns About Liability to Patients Not Examined by Stewardship Team
May 13, 2020

The Society for Healthcare Epidemiology of America today released a white paper outlining strategies for documenting the recommendations of antibiotic stewardship programs (ASP) and clarifying the stewardship team’s role in patient care from a legal and quality improvement standpoint. The white paper, titled Legal Implications of Antibiotic Stewardship Programs, was published in the journal, Infection Control and Hospital Epidemiology.

“Antibiotic stewardship has become a critical tool for healthcare systems to slow the emergence of antibiotic-resistant bacteria and to improve patient outcomes and safety,” said Keith Hamilton, MD, a member of the SHEA Antimicrobial Stewardship Committee and author of the white paper. “However, it is important to address the legal implications of antibiotic stewardship programs, particularly around concerns about professional liability stewards may have to patients that they do not see or examine with the goal of disseminating best practices and reinforcing the essential roles that these programs play in all healthcare settings.”

The paper provides strategies to address common concerns and perceptions surrounding the legal implications of stewardship programs with the goal of improving the structure and function of the programs, as well as the benefits they provide to patients and patient care.

The guidance, based on expert consensus and a review of case law, addresses documentation, covers clinical training of stewardship program personnel, tele-stewardship, the use of clinical practice guidelines, and antibiotic stop orders. The authors surveyed SHEA members about concerns around the structure of antibiotic stewardship programs, interventions, and documentation to ensure the guidance reflected realities and concerns from the field.

While there have been no specific lawsuits filed involving ASP, the authors note three important components that should be included in hospitals’ programs to reduce liability and further advance the goals of ASP strategies.

  1. Protocols to communicate and resolve differences with treating teams or other stakeholders to help achieve agreement on treatment strategy whenever possible.
  2. Documentation practices in electronic health records to provide the basis of recommendations as well as preserve the record of ASP involvement.
  3. Standards for credentialing ASP team members based on experience or formal training to ensure team member roles are aligned with expertise, licensure, and scope of practice regulations.


George Maliha, Mary Ellen Nepps, Pranita Tamma, Elizabeth Dodds Ashley, Julia Szymczak, Emma Kolesar, Keith Hamilton. “Legal Implications of Antibiotic Stewardship Programs.” Infection Control & Hospital Epidemiology. Web (May 13, 2020).

About ICHE
Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 41st out of 89 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.

The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society’s work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at and

About Cambridge University Press
Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. Its extensive peer-reviewed publishing lists comprise 45,000 titles covering academic research, professional development, over 400 research journals, school-level education, English language teaching and bible publishing. Playing a leading role in today’s international marketplace, Cambridge University Press has over 50 offices around the globe, and it distributes its products to nearly every country in the world.

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