Antimicrobial Stewardship

What is antimicrobial stewardship?

Antimicrobial stewardship programs (ASPs) are multidisciplinary team efforts within a healthcare facility focused on promoting proper prescribing of antimicrobials (including antibiotics) by providing feedback to prescribers.  ASPs aim to reduce excessive antimicrobial use, both in terms of length of therapy and in limiting the use of unnecessarily broad-spectrum agents.  The goal is to reduce the incidence of multidrug-resistant organisms (MDROs) to improve patient outcomes.

The Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS) and the Joint Commission all promote implementation of ASPs.  Infectious Disease physicians are frequently utilized as medical directors of ASPs because of their expertise in the use of antimicrobials.

Why use teleID for my ASP?

  • Meet Joint Commission requirements.  In 2017, the Joint Commission (TJC) established a standard for all hospitals to maintain an Antimicrobial Stewardship Program (ASP) with a team including an ID physician, where available (1).  Both TJC and the Infectious Diseases Society of America (IDSA) support the use of telemedicine to direct an ASP (1,2).

  • Improve quality metrics.  More than half of all hospitalized patients receive antibiotics (3).  It is estimated that a third of these prescriptions are inappropriate (4).

 

  • Save money.  In addition to helping facilities curb antimicrobial resistance, ASPs have also demonstrated consistent annual savings of $200,000 to $400,000 per facility (5).  Some facilities have reported annual savings up to $900,000 from implementing an ASP (6)

  • Supplement existing ID care.  Even if your facility already has ID consultants, a telemedicine-based ASP can help you save money without taking business from the existing ID group (7)

Joint Commission expands ASP requirements

Starting January 1, 2020, TJC will require all outpatient facilities that "routinely prescribe antimicrobial medications" to have an ASP.

TJC specifies five elements for outpatient ASPs:

  • Selecting an individual responsible for developing and monitoring appropriate prescribing practices

  • Setting at least one antimicrobial stewardship goal every year

  • Completing ASP goals in an evidence-based fashion

  • Educating staff and facility practitioners on ASP goals and appropriate prescribing practices

  • Collecting and analyzing data related to antimicrobial use

Do you have what it takes to meet new ASP requirements for your clinic?

References

  1. The Joint Commission. Prepublication Standards – New Antimicrobial Stewardship Standard, June 22, 2016.

  2. Siddiqui J et al, Clinical Infectious Diseases, Volume 64, Issue 3, 1 February 2017, p 237–242

  3. Baggs J et al. JAMA Internal Medicine 2016; 176(11):1639-48.

  4. Hecker MT et al. Archives of Internal Medicine 2003; 163(8): 972-8.

  5. https://www.cdc.gov/antibiotic-use/stewardship-report/improving-antibiotic-use.html

  6. Doron S, Davidson LE. Mayo Clin Proc. 2011 Nov;86(11):1113-23.

  7. Shively NR et al. Clinical Infectious Disease. ciz878, https://doi.org/10.1093/cid/ciz878

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