Standard for Antimicrobial Stewardship in hap, CAH, and ncc or Antibiotic Stewardship and You Clint Rohner, PharmD EIRMC Clinical Coordinator, former AMP lead October 28, 2016

TYPES OF FACILITY AFFECTED: Cah: critical access hospital Hap: hospital accreditation program Ncc: nursing care center

TYPES OF FACILITY AFFECTED: ahc & obs Ambulatory surgery centers Medical group practices Community health centers Imaging centers Office-based surgery Urgent care centers Sleep centers Obs: office based surgery

Antibiotic resistance Progression over time PCN to fire Evolutionary memory Mec-A Plasmid transmission World wide petri dish Simply put: We are losing

What is the answer? Change the culture Prevention #1 New products #2 AMP- antibiotic management programs

Antibiotics production New products are needed 2020 initiative Financial incentive Inherent problem of access

The “norm” for a practitioner… A few effective options for most disease states A set dose and duration Unintended consequences- C.Difficile Other resistance Individual biome We need to do better…

Antibiotics Stewardship For the Individual Optimize the therapy Right drug Penetration Concentration Duration

Antibiotics Stewardship For the Facility Aggregate Identify Educate Track

Core measure vs condition of participation The why “your ceo cares” discussion Core measures come with penalties Condition of participation come with “death sentances”

Standard MM.09.01.01 The organization has an antimicrobial stewardship program based on evidence-based national guidelines.

Elements of Performance for MM.09.01.01 Leaders establish antimicrobial stewardship as an organizational priority. (See also LD.01.03.01, EP5)

EP Text for MM.09.01.01, EP 2 Educate staff and licensed independent practitioners involved in antimicrobial ordering, dispensing, administration, and monitoring about antimicrobial resistance and antimicrobial stewardship practices. Education occurs upon hire and annually thereafter.

EP Text for MM.09.01.01, EP 3 Educate patients, and their families as needed, regarding the appropriate use of antimicrobial medications, including antibiotics. Note: An example of an educational tool that can be used for patients and families includes the Centers for Disease Control and Prevention’s Get Smart document, “Viruses or Bacteria—What’s got you sick?” at http://www.cdc.gov/getsmart/community/downloads/getsmart- chart.pdf

EP Text for MM.09.01.01, EP 4 The organization has an antimicrobial stewardship multidisciplinary team that includes the following members, when available in the setting: - Pharmacist(s) - Infection disease physician - Infection preventionist(s) Note: Part-time or consultant staff are acceptable as members of the antimicrobial stewardship multidisciplinary team.

EP Text for MM.09.01.01, EP 5 The practice's antimicrobial stewardship program includes the following core elements: - Leadership commitment - Accountability - Drug expertise - Action - Tracking

EP Text for MM.09.01.01, EP 5 The practice's antimicrobial stewardship program includes the following core elements: - Reporting - Education (See also IC.02.01.01, EP 1) Note: These core elements were cited from the Centers for Disease Control and Prevention’s Core Elements of Hospital Antibiotic Stewardship Programs (http://www.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf). The Joint Commission recommends that organizations use this document when designing their antimicrobial stewardship program

EP Text for MM.09.01.01, EP 6 The organization’s antimicrobial stewardship program uses organization-approved multidisciplinary protocols. Note: Examples of protocols are as follows: - Plan for Parenteral to Oral Antibiotic Conversion - Guidelines for Antimicrobial Use in Adults - Formulary Restriction - Preauthorization Requirements for Specific Antimicrobials - Assessment of Appropriateness of Antibiotics for Community Acquired Pneumonia - Guidelines for Antimicrobial Use in Pediatrics

EP Text for MM.09.01.01, EP 6 AHC- Treatment Guidelines for Common Infections - "Wait-and-See" Antibiotic Protocol NCC- Facility Guidelines for Antimicrobial Use in Adults - Care of the Long Term Care Patient with a Urinary Tract Infection OBS-Use of Prophylactic Antibiotics - Plan for Parenteral to Oral Antibiotic Conversion - Formulary Restriction - Preauthorization Requirements for Specific Antimicrobials

EP Text for MM.09.01.01, EP 7 The hospital collects and analyzes data on its antimicrobial stewardship program, including antimicrobial prescribing and resistance patterns. (See also MM.08.01.01, EPs 1 and 2)

EP Text for MM.09.01.01, EP 8 The organization takes action on improvement opportunities identified in its antimicrobial stewardship program. (See also MM.08.01.01, EP 6)

Pieces of my dream team Doctor Pharmacist Infection control Nursing Microbiology i.t. Upper leadership

Big- small- - you can do! Start with your “stars” Pick easy wins Be loud! If you don’t yell it, nobody will Measure everything before you start--- you must have a baseline to compare Get started- cheat- it really can be done

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Smaller hospital

Even smaller hospital- daily census < 10

Questions?? Google- joint commission standard for antibiotic stewardship