For many years, antimicrobial stewardship has been an increasingly hot topic, and for good reason – antimicrobial resistance, classified by the World Health Organization as “one of the biggest threats to global health,” is a growing problem.
Now regulatory and accrediting bodies have begun to require that hospitals and healthcare organizations act to minimize patient risk.
As of Jan. 1, 2017, the Joint Commission requires hospitals seeking accreditation to have an antimicrobial stewardship program, and rumors are circulating that the Centers for Medicare & Medicaid Services may also soon include a similar measure in its regulations. If your hospital is starting from square one, you may want to brush up on ASP basics and the best ways to get started; but if you already have a program, there are still many things you can do to maximize its success:
1. Engage all parties: When creating an ASP, it can be tempting to rely on the expertise of the most obvious committee member candidates, such as doctors, nurses and pharmacists. However, it is important to remember that virtually every hospital employee plays a role in the program’s success. Therefore, it is critical to loop in everyone, clearly explain their role, and provide regular education on ASP topics. For example, environmental services must understand that special measures are required when cleaning the room of a patient with Clostridium difficile or another highly virulent infection. Improper cleaning protocols could lead to an outbreak, sabotaging both patient health and program outcomes. TJC also calls for ASPs to engage not only hospital employees but also the patient and their caregivers in discussions and educations regarding the treatment of their infection.
2. Ensure thorough reporting: TJC requires accredited organizations to share ASP data throughout the healthcare system, and CMS is likely to do so in the future. Reporting is the best tool hospitals have to pinpoint the strengths and weaknesses of their program and promote its continuous improvement. Determine the most appropriate metrics for your hospital, understand how they align with your overall organizational objectives, and monitor them over time to see trends. In addition to monitoring medication utilization through days of therapy or defined daily doses, drug spend is also an important ASP measurement. Besides simply showing overall cost savings which is of interest to the C-suite, lower drug spend can also be a good sign that your ASP is helping your hospital to utilize appropriate durations of therapy, narrow antimicrobial spectrum and transition patients to oral treatments – all of which can help to decrease overall length of stay.
3. Brush up on best practices: When you launched your ASP, you likely based your new processes and protocols on a thorough audit of the latest research, best practices and case studies. To be maximally successful, it is key to keep the program dynamic and continue to update it according to new industry findings. It is important that doctors prescribe the right course of treatment by choosing an antimicrobial that targets the organism most likely to be causing the infection. Going further, the treatment must also be given via the appropriate route in a dose suitable for the patient’s renal function and only continued for the recommended length of time. If patients are unnecessarily exposed to antimicrobials by prescribers not sticking to these ideals, the patient may experience a variety of negative consequences, the overall cost of healthcare may be higher, and antimicrobial resistance may increase. Education efforts by the ASP team must be continually updated to ensure all members of the healthcare team have the tools that they need to prescribe the most efficacious course of treatment possible.
4. Communicate often: The efforts of the ASP team members to stay abreast of best practices are somewhat wasted if there’s not a way to disseminate that information to the broader healthcare team and ideally the entire hospital staff. Consider weekly, monthly or quarterly newsletters with customized updates for different hospital departments (e.g., doctors, nurses, pharmacists, environmental services, etc.). Investigate opportunities for key members of the ASP to present at various hospital committee meetings for different disciplines, such as surgical services or hospitalists, to discuss how antimicrobial stewardship affects the patients that they see. Encourage ASP team members to join the huddle of nurses at shift changes to gather information about any issues that may require a response. It may require some creativity, but leaving the line of communication open on both ends is the most surefire way to ensure your ASP is as relevant as possible to all stakeholders.
5. Partner with outpatient organizations: When it comes to antimicrobial stewardship, a “population health” approach is essential. As part of your ASP reporting, you’ll likely develop an antibiogram to understand which bacteria is most prevalent in your community and which antimicrobials are most effective at killing those bacteria. Armed with this knowledge, your ASP can educate not only the doctors in your hospital, but also outpatient partners to ensure patients are receiving appropriate treatment the first time they are seen – hopefully, helping them get better faster, keeping them out of the hospital and reducing overall antimicrobial resistance.
While it may have taken a back seat to other public health crises of late, antimicrobial resistance is still an urgent issue, and one that’s likely to stay on the radar of patients, policymakers and healthcare leaders for years to come. After a well-deserved pat on the back for launching an ASP (it’s not easy!), smart organizations will look ahead to what they can be doing to ensure that their program is well positioned for future success.
Paul T. Green, Pharm.D., MHA, BCPS is a Clinical Pharmacy Manager for CompleteRx, one of the nation’s leading pharmacy management companies, who currently heads the clinical programs for the Upper Allegheny Health System (UAHS) with hospitals along the New York / Pennsylvania boarder. He has over 10 years of clinical pharmacy experience advising hospital and healthcare executives across the country on various critical issues and has successfully implemented Antimicrobial Stewardship Programs for several healthcare systems. He has presented numerous lectures and posters at the local, state, and national level and will be giving a TED Talk on antimicrobial stewardship in November 2017. He is also the president-elect of the Northwest Chapter of the Pennsylvania Society of Health-System Pharmacists and is in the process of starting a new clinical pharmacy residency program for UAHS.
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