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Joint Commission Proposes New Standards for Antimicrobial Stewardship

Experts call for program based on evidence-based national guidelines

The Joint Commission has released its proposed standards for antimicrobial stewardship, which is now open for field review, according to HealthLeaders Media. The standards call for an “antimicrobial stewardship program based on evidence-based national guidelines” in ambulatory health care organizations, critical-access hospitals, hospitals, nursing care centers, and office-based surgery practices.

It’s not just the Joint Commission that wants to steer hospitals and other organizations toward implementing stewardship programs. There is also a push for having antimicrobial stewardship teams in each hospital as a condition for participation in Medicare/Medicaid by the end of 2017. Antimicrobial stewardship is likewise a priority at Northwestern Memorial Hospital in Chicago, which has had a formalized program since 2002.

According to the Centers for Disease Control and Prevention (CDC), the core elements of successful antimicrobial stewardship include:

  • Leadership Commitment: Dedicating necessary human, financial, and information technology resources.
  • Accountability: Appointing a single leader responsible for program outcomes. Experience with successful programs shows that a physician leader is effective.
  • Drug Expertise: Appointing a single pharmacist leader responsible for working to improve antibiotic use.
  • Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (e.g., an “antibiotic time out” after 48 hours).
  • Tracking: Monitoring antibiotic prescribing and resistance patterns.
  • Reporting: Regular reporting of information on antibiotic use and resistance to doctors, nurses, and relevant staff.
  • Education: Educating clinicians about resistance and optimal prescribing.

No matter how much momentum there is behind decreased and smarter antibiotic use, there will always be holdouts who resist change and “feel very strongly with their use of antibiotics,” even if it “doesn’t fall into line with approaches to modern antibiotic use,” Sarah Sutton, MD, medical director of the antimicrobial stewardship program at Northwestern Memorial Hospital, told HealthLeaders Media. Moreover, prescribers often learn from their mentors and do what they’ve been taught, thereby perpetuating inappropriate antibiotic use.

For these reasons, educating clinicians is critically important, Sutton said. Education efforts should include providing data in a way that is easily digested, such as showing scientific literature to clinicians, and sharing data about concrete improvements, such as differences in Clostridium difficile rates, when the institution is using fewer antibiotics. It is also important to reassure clinicians that they are not putting patients at risk when they change their antibiotic prescribing, Sutton said.

Sources: HealthLeaders Media; December 22, 2015; and The Joint Commission; November 17, 2015.

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