Antibiotic stewardship is a global issue and it’s something we all must address. At the facility level, it’s not only a regulatory concern, it’s a patient safety issue. With the ongoing global spread of the Novel Coronavirus (COVID-19), the issue of antibiotic stewardship (already a significant focus by the certification and accreditation bodies), has been pushed even further out into the spotlight. Beyond just being a survey challenge, antibiotic stewardship can have a profound impact on patient outcomes — not only today’s patients, but also future patients.
Is your healthcare facility’s antibiotic stewardship program complete? Are you following nationally recognized guidelines? Are your policies up-to-date? Let your consultant pharmacist ensure regulatory and clinical compliance (and, if you don’t have a consultant pharmacist yet, consider using one).
The Centers for Medicare and Medicaid Services (CMS) has announced specific actions to address the spread of COVID-19 that will have a direct impact on antibiotic stewardship. While we all know that having an infection control and prevention program is a condition for participation in the federal program, did you know that directly under the umbrella of infection control and prevention is antibiotic stewardship?
Among the immediate recommendations CMS is making, is that “all health care providers must immediately review their procedures to ensure compliance with CMS’ infection control requirements, as well as the guidelines from the Centers for Disease Control and Prevention (CDC).” Additionally, until further notice, State Survey Agencies and Accrediting Organizations such as the Accreditation Association for Ambulatory Health Care (AAAHC), The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and The Joint Commission (TJC) will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats.
Though it’s true that antibiotics are not used to treat viral infections such as COVID-19, the increased scrutiny on infection control programs will undoubtedly put additional focus on antibiotic stewardship. It’s also significant to note that patients who become ill may develop secondary bacterial infections that will require management with antibiotics.
According to the Centers for Disease Control (CDC), antibiotic resistance is among the greatest of public health threats today, leading to an estimated 2 million infections and 23,000 deaths per year in the United States.
What is antibiotic stewardship?
According to The Society for Healthcare Epidemiology of America (SHEA), antibiotic stewardship refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics, and decreasing unnecessary costs.
How can your facility prevent antibiotic resistance?
According to the Association for Professionals in Infection Control and Epidemiology (APIC), there are three steps you can take:
- Take action to prevent the spread of resistant organisms.
- Report resistant organisms as required by your state health department.
- Improve your facility’s use of antibiotics by prescribing carefully.
Where do you start?
Antibiotic stewardship begins with education and a great place to start is the CDC’s Core Elements of Antibiotic Stewardship. Here, you can learn about site specific steps you can take to develop and implement a system. Targeted areas include outpatient settings, hospitals and nursing homes. Your consultant pharmacist should be familiar with these elements and can help guide you on implementation and monitoring, but don’t stop here. There are more resources available (your consultant pharmacist should be well positioned to lead this effort).
How can your consultant pharmacist can help?
The CDC recommends that you utilize pharmacy expertise and appoint a pharmacist as leader, or co-leader, of your antibiotic stewardship program.
Your pharmacist can also help with the following to help safeguard your antibiotic stewardship:
Chart audits: During each visit to my facilities in my work as a consultant pharmacist, 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?
These are all questions that can be answered with a good chart audit that can then be used for education to change patterns.
Benchmarking: The data collected during chart reviews, along with additional facility provided data can be collected and used to develop benchmarking studies. These studies allow facilities to compare their past performance to current performance and externally to the performance of other facilities.
Antibiotic stewardship is one of the key components and is a great tool for assessing their prescribing patterns to enhance patient outcomes.
Policy and procedure: Do you have policies and procedures to address appropriate antibiotic use? If you already have policies in place, have your consultant pharmacist review them.
This is a good opportunity to ensure you are using the most current standards. If you are unsure, or know you don’t have policies in place, working with a consultant pharmacist (such as our team here at OctariusRX) can help you develop new policies.
Drug shortages/Formulary management: The first thought that probably comes to mind when discussing drug shortages is that ambulatory care facilities, among other patient care facilities, may have to delay or cancel surgeries due to unavailable medications.
Although the COVID-19 outbreak may impact production, the truth is that overbuying and hoarding of medications will likely also impact availability. The most commonly impacted classes are antibiotics, anesthetics and controlled substances…but how would that impact antibiotic stewardship? If an antibiotic is unavailable, it requires using an alternative — and not all alternatives are appropriate for every procedure.
Having the expertise of a consultant pharmacist will allow you to make informed decisions that can increase patient safety while at the same time reducing inappropriate use of antibiotics.
If you are currently struggling to get your antibiotic stewardship program off the ground or you feel your policies aren’t quite up to current standards, consultant pharmacists such as our team here at OctariusRX can help. Contact us for a free consultation today: we have helped many facilities along the way and we promise to guide you through every step to ultimately make your healthcare facility fully compliant!
Additional COVID-19 Resources:
Regarding the COVID-19 outbreak, this is a quickly evolving situation and information is changing quickly. We suggest you stay abreast of the most up-to-date information by checking frequently. Here is a list of resources to help guide you:
- The CDC:
Coronavirus Disease 2019 (COVID-19)
https://www.cdc.gov/coronavirus/2019-ncov/index.html - CMS Resources:
Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19):
FAQs and Considerations for Patient Triage, Placement and Hospital Discharge
https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/guidance-infection-control-and-prevention-concerning-coronavirus-disease-covid-19-faqs-and
Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes
https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/guidance-infection-control-and-prevention-coronavirus-disease-2019-covid-19-nursing-homes
- The Massachusetts Department of Public Health
Information on the Outbreak of Coronavirus Disease 2019 (COVID-19)
https://www.mass.gov/resource/information-on-the-outbreak-of-coronavirus-disease-2019-covid-19
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.
