Just as a supply chain team should monitor medical supplies traveling throughout the hospital, so too should clinicians maintain a keen eye on antimicrobial medication orders.
Antimicrobial stewardship programs — used to promote safer, more efficient antimicrobial use — not only improve patient outcomes and discourage antimicrobial resistance, but also reduce costs due to fewer medication orders and shorter hospital stays. A study conducted by the University of Maryland in College Park showed one antimicrobial stewardship program reduced hospital costs by $17 million over eight years, according to the CDC.
Kathy Chase, PharmD, serves as director of Innovative Delivery Solutions for Cardinal Health. She attended the University of Nebraska College of Pharmacy in Omaha and holds more than a decade of experience at Cardinal Health. In her role at the Dublin, Ohio-based supply chain solutions provider, she helps hundreds of hospital pharmacies implement strategies using a three-tiered approach to provide assessment, implementation and analytics solutions to help health systems effectively reduce costs and benchmark their progress.
Ms. Chase spoke to Becker's Hospital Review about the benefits of antimicrobial stewardship programs, along with tips on how to implement a successful program.
Note: Responses have been lightly edited for length and clarity.
Question: What is antimicrobial stewardship?
Kathy Chase: Antimicrobial stewardship can best be defined as a coordinated effort to improve antibiotic use, including selection, dosing, route and duration of therapy. Principles of antimicrobial stewardship can be applied in any healthcare setting, including the patient's home. The ultimate goal of antimicrobial stewardship surrounds improving patient outcomes, reducing microbial resistance and decreasing the spread of infections caused by multidrug-resistant organisms.
Q: What prompted the development of antimicrobial stewardship programs?
KC: Pharmacists and physicians have applied antimicrobial stewardship principles for several decades. The concept of a formal antimicrobial stewardship program was developed to enhance those initial efforts. With the ever-growing threat of new multidrug-resistant organisms, the dwindling antibiotic pipeline and literature demonstrating up to 50 percent of antibiotic use is inappropriate or unnecessary, clinicians and healthcare leaders realized something must be done. The solution was to formalize the way we approach antimicrobial use, prescribing and reporting. Today regulatory bodies like the CDC and the Joint Commission maintain standards requiring hospitals to develop antimicrobial stewardship programs.
Q: What are the seven core elements of an antimicrobial stewardship program?
KC: In 2014, the CDC published a document describing the seven core elements of successful hospital ASPs. These include: leadership commitment — dedicating necessary human, financial and information technology resources; accountability — appointing a single leader responsible for program outcomes; drug expertise — appointing a pharmacist leader responsible for working to improve antibiotic use; action — implementing at least one of the CDC's recommended actions, like conducting an "antibiotic time out" after 48 hours to assess the need for ongoing treatment; tracking — monitoring antibiotic prescribing and resistance patterns; reporting — regularly communicating information on antibiotic use and resistance to relevant staff; and education — teaching clinicians about resistance and optimal prescribing methods. These core elements complement existing regulatory requirements and national guidelines for antimicrobial stewardship.
Q: What are the positive and negative outcomes of antimicrobial stewardship programs for hospitals?
KC: The main goal for an antimicrobial stewardship program should always be to improve patient care. A successful program should reduce inappropriate antimicrobial use and decrease its secondary consequences — like C. difficile-associated diarrhea — as well as lower the incidence of infections over time caused by multi-drug resistant organisms. That said, there may be some growing pains associated with developing these programs. Leadership may offer limited support for the program or display a lack of awareness regarding the importance of proper antimicrobial use. Prescribers may feel a loss of independence by having to adhere to new hospital guidelines. For the pharmacy, having to shift staff to cover stewardship duties may create a perceived burden on other clinical areas.
Fortunately, most of these initial challenges have solutions. A strong business case can show that successful stewardship programs actually add clinical and economic value to the organization. Having physician buy-in during guideline development can prevent resistance downstream and pharmacy departments can prevent burnout by starting with one to two simple goals, like starting an IV to PO program or requiring indications on all antibiotic orders.
Q: Can hospitals of any size successfully implement an antimicrobial stewardship program?
KC: Yes, hospitals of any size can implement antimicrobial stewardship programs. For smaller hospitals with limited resources, stewardship duties can be allocated across several departments. For hospitals without access to an infectious disease physician, hospitalists with an interest or knowledge of infectious diseases can also serve as program leaders. Pharmacies can consider offsite infectious diseases support. Automated alerts and guidelines at order entry can decrease the need for manual interventions. The important thing to keep in mind is the commitment to improve patient care. Even in the smallest facility, each intervention, each recommendation to improve antibiotic use will make a difference for future patients.
More articles on supply chain:
St. Jude Medical identifies data, battery malfunctions in pacemaker: 4 things to know
5 latest FDA approvals
EpiPen price hikes cost DOD millions