This week we are discussing best practices on how to avoid antibiotic stewardship deficiencies.

Does your facility have a comprehensive program in place as part of the overall infection control program? Do you have a staff member who develops and oversees your program? How is your pharmacy consultant helping you?

Your pharmacy consultant can help you avoid antibiotic stewardship deficiencies and sail smoothly through your next survey. Does your consultant pharmacist help provide guidance on infection control? They should, and in this post, we will discuss some of the ways your pharmacy consultant can make your patients safer and your surveys easier.

What is antibiotic stewardship?

According to the Association for Professionals in Infection Control and Epidemiology (APIC), antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multi-drug resistant organisms.

Surveys have not gotten easier through the years, and the COVID-19 pandemic had only made them more challenging. Infection control and antibiotic stewardship have been areas of constant focus for licensing and accrediting organizations such as the Centers for Medicare and Medicaid Services (CMS), Accreditation Association for Ambulatory Health Care (AAAHC), The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and The Joint Commission (TJC).

As usual, many of the deficiencies in this category result from one of two things: Either the facility does not have a policy and procedures in place, or the policy exists, but is not being followed or is being followed incorrectly. Each facility should have an antibiotic stewardship policy available for surveyors to review. The policy should highlight the commitment to program goals, who is accountable, and the steps required to implement the antibiotic stewardship program.

A good place to start is by following the Centers for Disease Control and Prevention’s (CDC) Core Elements of Antibiotic Stewardship:

• Commitment: Demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety.
• Action for policy and practice: Implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed.
• Tracking and reporting: Monitor antibiotic prescribing practices and offer regular feedback to clinicians, or have clinicians assess their own antibiotic prescribing practices themselves.
• Education and expertise: Provide educational resources to clinicians and patients on antibiotic prescribing and ensure access to needed expertise on optimizing antibiotic prescribing. This is an area of expertise where the CDC stresses and encourages facilities to use the services of a pharmacist. Beyond having an infection control program that is based on nationally recognized guidelines, ASCs should have a dedicated infection preventionist to help ensure compliance with state and national infection prevention requirements. Consistency at this position is essential, but the ongoing staffing shortages, along with above average staffing turnover, makes this a challenge.

How can your consultant pharmacist help with antibiotic stewardship?

Your pharmacist can supplement and enhance your infection control program and help you maintain compliance with antibiotic stewardship requirements in a variety of ways:

1. Review antibiotic prescribing: As part of their routine visits, your pharmacy consultant can review antimicrobial use patterns and report back to the facility.
2. Review right drug, dose, and timing and duration. This should be done at each visit and can also be included in benchmarking studies to allow for internal and external comparison and quality improvement.
3. Safe injection practices: Although not always intuitive, safe injection practices play a large role in proper infection control and antibiotic stewardship. Your consultant pharmacist should be expert here too, and as a result, can guide you on best practices.
4. Policy development: Not all pharmacists provide policy development or guidance. Ensure you are working with one that has a great understanding of the licensing and accreditation requirements and can help you in this area. Policy review is an expectation, but policy development is just as important.
5. Chart audits: During each visit to my facilities, I review charts to ensure compliance with several standards. Are antibiotics being used according to the guidelines? Are they timed properly in relation to the time of surgery? Is the correct antibiotic being used?

Infection control plays a big role in just about everything that happens in the healthcare setting. Being compliant with licensing and accrediting standards around antibiotic stewardship requires a lot of planning and expertise. Consultant pharmacists who specialize can be an invaluable tool to help facilities establish processes to enhance patient safety and regulatory compliance. If you have questions about this post or need help developing or improving your antibiotic stewardship program, let us know and we will guide you.

The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.