Antimicrobial Stewardship Program Development

Antimicrobial stewardship (AMS) refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy and route of administration. Appropriate antibiotic use is a huge undertaking for the healthcare industry. Managing multi-drug resistant organisms to ensure patient safety and public health requires attention to the use and misuse or overuse of antimicrobials.

Over the course of the past few years, a major emphasis has been placed on developing and maintaining AMS programs. Acute-care facilities/hospitals have slowly introduced the concept of AMS through efforts and programs (small and large) governed by pharmacy and therapeutics committees, infection prevention and control committees, performance improvement/quality assurance committees and medical executive committees.

While much of the early focus on AMS centered on acute-care settings, 2016 brought increased efforts at a federal level to include outpatient care, including ambulatory surgery centers and long-term care facilities. By 2020, it is expected that there will be a reduction of inappropriate antibiotic use by 50% in outpatient settings and 20% in inpatient settings, and establishment of State Antibiotic Resistance Prevention (Protect) Programs in all 50 states.

The Joint Commission recently announced a new AMS standard for acute care, critical access hospitals and nursing care centers (nursing homes) effective January 1, 2017. This standard — MM.09.01.01 — addresses elements of performance (EPs) including educating patients and families on appropriate use of antibiotics. Hospitals and nursing care centers will be held to this standard during surveys.

Nursing homes and other long-term care settings face major challenges in controlling the use of antimicrobials and progressing in developing AMS programs. Since AMS is a newer concept, efforts to engage physiatrists and geriatricians to weigh in on appropriate antibiotic use, particularly in the elderly, has been met with obstacles.

Outpatient clinic visits often lead to ordering of antibiotics, and we see many more antibiotic resistant organisms in the community than a decade ago. The outpatient care setting has a challenge to change the culture of injudicious use of antimicrobials.

ICCS assists facilities across the spectrum of care with development of AMS programs in accordance with guidelines, standards and regulatory requirements.

 

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