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Why is an Antimicrobial Stewardship Program Important?

It’s that time of year again, when colds, upper respiratory Infections and the flu tend to sneak into our lives.  Patients and consumers should remember that the prescribing of antibiotics should be less in this era of Antibiotic Stewardship.  But what is Antibiotic Stewardship and why is it important.  To learn more, read on….

APIC’s definition of antimicrobial https://apic.org/professional-practice/practice-resources/antimicrobial-stewardshipAntimicrobial stewardship is a coordinated program that focuses on and supports the appropriate use of antimicrobials or which antibiotics improve patient outcomes, reduce microbial resistance, and decrease the spread of infections caused by multidrug-resistant organisms.  Although the terms “antimicrobial stewardship” and “antibiotic stewardship” are used interchangeably, antimicrobial stewardship promotes the appropriate use of all antimicrobials, including antibiotics, antivirals, antiprotozoals, and antifungals. Antibiotic stewardship is a subset of antimicrobial stewardship, that includes interventions to prevent drug-resistant bacterial infections through specific antibiotic therapy targeted toward susceptible or resistant bacteria, and reduce unnecessary or inappropriate antibiotic use.

Why is Antimicrobial stewardship important?   An Antimicrobial Stewardship Program (ASP) is

designed to provide guidance for the safe and cost-effective use of antimicrobial agents. The primary goal of the ASP is to optimize clinical outcomes while minimizing unintended consequences related to antimicrobial usage, such as toxicities or the emergence of resistance.

The primary goal of the ASP is to optimize clinical outcomes while minimizing unintended consequences related to antimicrobial usage. . .

The CDC at https://www.cdc.gov/antibiotic-use/core-elements/hospital addresses interventions that include broad, pharmacy-driven and infection and syndrome specific:

Stewardship interventions are can be categorized as broad, pharmacy-driven; and infection and syndrome specific. Broad interventions may include an evidence-based practice and revisiting the antibiotic(s) ordered for a patient. Antibiotics are often started routinely in hospitalized patients while diagnostic information is being obtained.  However, providers may not revisit the selection of the antibiotic after more clinical and laboratory data is available.

Pharmacy-driven interventions should include: Automatic changes from intravenous to oral antibiotic therapy, dose adjustments, automatic alerts in situations where therapy might be unnecessarily duplicativetime-sensitive automatic stop orders, detection and prevention of antibiotic-related drug-drug interactions.

Infection or syndrome specific interventions are associated with such conditions as a community acquired pneumonia, UTIs, MRSA, & Clostridium difficile infections, & treatment of culture proven invasive infections. 

Important core elements of Hospital Antibiotic Stewardship Programs include:

  • Leadership Commitment: Encompasses dedicating necessary human, financial and information technology resources.  Supporting the implementation of policies or protocols, education of staff and improving antibiotic usage.
  • Accountability: Appointing a single leader responsible for program outcomes.  Some successful programs have found that a physician leader is effective.  It is also important to identify a single pharmacy leader to co-lead the program.
  • Drug Expertise: Appointing a single pharmacist leader to be responsible for improving antibiotic use to have the oversight and provide expertise.
  • Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment after a set time period of initial treatment such as after 48 hours.
  • Tracking:  Monitoring antibiotic prescribing and resistance patterns
  • Reporting: Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff
  • Education: Educating clinicians about policies or protocols, resistance, and optimal prescribing

The Joint Commission on Accreditation’s Hospital Program standard MM.09.01.01 EPs 1,2,4,5,6,7, & 8 address specific requirements related to antibiotic stewardship including that leaders establish it as an organization priority, educate staff and licensed independent practitioners, establish an antimicrobial stewardship multidisciplinary team,  antimicrobial stewardship program includes the following core elements as address above , the hospital’s antimicrobial stewardship program uses organization-approved multidisciplinary protocols; the hospital collects, analyzes, and reports data on its antimicrobial stewardship program; and the hospital takes action on improvement opportunities identified in its antimicrobial stewardship program.

Additional Reference:

The Joint Commission Comprehensive Accreditation Manual for Hospitals 2019

 

Carol Mooney, MSN, RN, CPHQ

Author Carol Mooney, MSN, RN, CPHQ

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