Getting in Gear: Anti-Microbial Stewardship – Not Just for Hospitals Anymore | Joint Commission

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Getting in Gear: Anti-Microbial Stewardship – Not Just for Hospitals Anymore

Oct 25, 2016 | 4374 Views

By Phenelle Segal, RN, CIC
Infection Control Consulting Services

Antibiotic resistance is currently a hot topic in health care. As an ambulatory care provider, is your knowledge up to date? Here’s what you need to know.

Anti-microbial stewardship (AMS) refers to coordinated interventions designed to improve and measure the appropriate use of anti-microbials by promoting the selection of:

  • Optimal anti-microbial drug regimen
  • Dose
  • Duration of therapy
  • Route of administration

The Move to Ambulatory Settings
For several years, due to the increasing incidence of multi-drug resistant organisms (MDROs), emphasis has been placed on developing and maintaining AMS programs in acute-care settings. However, with healthcare services shifting at a dramatic rate to the ambulatory setting for medical and surgical care, healthcare professionals including physicians, pharmacists and infection preventionists, expect AMS to cross the continuum of care.  AMS efforts at the federal level began in 2014 when President Obama issued an executive order to combat antibiotic resistant bacteria.

Per the executive order, practices were urged to:

  • Advance research to develop new antibacterial drugs, vaccines, diagnostics, and other novel therapeutics
  • Strengthen surveillance efforts in public health and agriculture
  • Develop and promote the use of new, rapid diagnostic technologies
  • Work with the pharmaceutical industry to include information on the proper use of over-the-counter and prescription antibiotic medications for humans and animals

The order specifically called for incorporating AMS into ambulatory care. Ambulatory care settings include, but are not limited, to clinical practices; ambulatory surgery centers (ASCs) and dialysis centers.

By 2015, the White House issued a national action plan which includes an extensive list of goals and expectations. By 2020, significant outcomes in this area will include:

  • Establishment of anti-microbial stewardship programs in all acute care hospitals and improved stewardship across all healthcare settings
  • Reduction of inappropriate antibiotic use by 50% in outpatient settings and 20% in inpatient settings
  • Establishment of programs in all 50 states

Joint Commission Medication Management Standard
You may already be aware that in June 2016, The Joint Commission released a new standard relating directly to AMS: medication management (MM) standard MM.09.01.01. This standard will be effective in January 2017 for all hospitals, critical access hospitals and nursing care centers.

This standard was developed as a follow-up to the 2015 White House Forum on Antibiotic Stewardship and goes into effect in a few short weeks.

So what can you do? While the standard itself doesn’t provide a direct call to action for ambulatory care centers, they still need to jump in the AMS game. Ambulatory care centers should seriously focus on developing their AMS programs without delay as both government and accreditors ramp up their efforts to implement changes in anti-microbial use. The Joint Commission may be developing ambulatory versions of the AMS standards beginning in 2017, so start preparing now.

Especially as this is uncharted territory, no ambulatory provider is expected to create an AMS plan without guidance. The Joint Commission says they’re here to help. Please do not hesitate to call the Standards Interpretation Group for support, at 630-792-5900, x3.

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