A New Standard Of Stewardship

Published on 12 June 2017

The need to reduce the use of inappropriate antimicrobials across all health care settings in response to growing antimicrobial resistance is among the most discussed topics in health care today. As reported by the World Health Organization in its May 2016 fact sheet, “Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.”

Adding to the threat, 20 to 50 percent of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate, according to the Centers for Disease Control and Prevention (CDC).

Held in June 2015, the White House Forum on Antibiotic Stewardship sought the commitment of The Joint Commission and more than 150 representatives of major health care organizations, food companies, retailers and animal health organizations to implement changes over the next five years. Through the responsible use of antibiotics, the changes are intended to slow the emergence of antibiotic-resistant bacteria, detect resistant strains, preserve the efficacy of existing antibiotics and prevent the spread of resistant infections.

“This issue is far reaching because 70 percent or more of antibiotics used in the U.S. in a single day are used in the animal industry,” said Ryan P. Moenster ’04/’05, Pharm.D., BCPS, associate professor of pharmacy practice and interim director of the division of specialty care pharmacy. “The cocktail of antibiotics given to livestock makes its way into our food and into wildlife from industrial waste, which breeds resistance. Organisms are rapidly developing resistance to the available antimicrobial agents, and we are not developing new antibiotics at a very fast rate.”

As health care organizations work to reduce the threat of antimicrobial resistance, pharmacists are playing an integral role. The Joint Commission’s recent Medication Management standard on antimicrobial stewardship, MM.09.01.01, recognizes the value of pharmacists as it outlines the latest requirements for hospitals, critical access hospitals and nursing care centers.

“Antimicrobial stewardship is multifaceted.” said Scott Micek, Pharm.D., FCCP, BCPS, associate professor of pharmacy practice. “To fully practice this approach, interdisciplinary teams that include pharmacists must ensure the optimal selection, dose and duration of antimicrobials leading to the best clinical outcome while producing the fewest possible side effects. The risk for subsequent resistance can be minimized. A pharmacist’s knowledge of antimicrobial pharmacokinetics, pharmacodynamics and local antibiograms, along with a detailed understanding of the research for various infections, promotes stewardship in every sense of the definition.”

The new standard was developed with significant support from the Centers for Medicare & Medicaid Services, the CDC and the Society for Healthcare Epidemiology of America. After developing the new standard and conducting a field review, MM.09.01.01 became effective on Jan. 1 for hospitals, critical access hospitals and nursing care centers. The standard consists of seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting and education. A particular emphasis is placed upon the role of the pharmacist as part of a multidisciplinary team. As outlined in The Joint Commission requirements, each antimicrobial stewardship multidisciplinary team must include an infectious disease physician, infection preventionist(s), pharmacist(s) and a practitioner. To comply with the drug expertise component of element five of the standard, a single pharmacist leader must be appointed and made responsible for working to improve antibiotic use.

“This new standard increases the need for pharmacists to be trained in antimicrobial stewardship or infectious diseases,” Moenster said. “It is going to create jobs and put an emphasis on educating pharmacists and their patients. As approaches on how to address antimicrobial stewardship in outpatient settings are being developed, community pharmacists will be key in educating their patients on the appropriate use of their antibiotics.”

The success of the standard and reduction of the inappropriate use of antimicrobial agents relies heavily upon collaboration from a wide range of industries and specialists. However, it is clear pharmacists will play a critical role in the fight against antimicrobial resistance. From pharmacy researchers in labs developing new antibiotics to community pharmacists educating patients, a pharmacist’s commitment to antimicrobial stewardship will be inherent in every step of the process.

 

This story was first published in the spring 2017 issue of Script. Visit stlcop.edu/script to read more and access previous issues