Health Systems Can Play a Pivotal Role in Supporting Antimicrobial Stewardship

Health Systems Can Play a Pivotal Role in Supporting Antimicrobial Stewardship Clinical Infectious Diseases C O RRESP O NDEN CE Health Systems Can Play a Pivotal Conflicts of Interest. Conflicts that the editors guide clinicians in testing and treatment. Role in Supporting Antimicrobial consider relevant to the content of the manu- We continue to partner with the CDC to Stewardship script have been disclosed. submit data through the antimicrobial TO THE EDITOR—We read with great inter- Mohamad G. Fakih, Roy Guharoy, Ann Hendrich, and use and resistance module so we can Ziad Haydar est the results of the National Healthcare benchmark against other facilities and Care Excellence, Ascension Health, St Louis, Missouri Safety Network survey evaluating the identify potential opportunities for countrywide implementation of the Cen- improvement. References ters of Disease Control and Prevention We are ready to comply with the Joint 1. Pollack LA, van Santen KL, Weiner LM, Dudeck MA, (CDC) antimicrobial stewardship core Commission Standards [3] effective Edwards JR, Srinivasan A. Antibiotic stewardship elements [1]. As the United States’ largest programs in U.S.: acute care hospitals: findings January 2017 and the Centers for Medi- from the 2014 National Healthcare Safety Network not-for-profit healthcare system with 141 care & Medicaid Services’ proposed annual hospital survey. Clin Infect Dis 2016; hospitals and serving 24 states, Ascension 63:443-9. conditions for participation [4]related 2. The White House. National action plan for combat- answered the call for commitment to the to antimicrobial stewardship. However, ing antibiotic-resistant bacteria, 2015. Available at: White House report on Combating Anti- https://www.whitehouse.gov/sites/default/files/docs/ what is more important is that we are see- national_action_plan_for_combating_antibotic- biotic-Resistant Bacteria (CARB) [2] and ing concrete improvements in antimicro- resistant_bacteria.pdf. Accessed 6 August 2016. pledged to align with the CARB goals 1 bial use. Over the last year, we have been 3. The Joint Commission. Prepublication requirements. and 2. We established facility-based anti- New antimicrobial stewardship standard. Available able to reduce systemic antibiotic use by at: https://www.jointcommission.org/prepublication_ microbial stewardship programs (ASPs) 8%. This has been accomplished by (1) standards_antimicrobial_stewardship_standard/. and incorporated the CDC core elements Accessed 6 August 2016. making antimicrobial stewardship a sys- 4. Centers for Medicare & Medicaid Services. CMS issues at all Ascension hospitals. At the national tem priority with full leadership support; proposed rule that prohibits discrimination, reduces level, our system antimicrobial steward- hospital-acquired conditions, and promotes antibio- (2) creating an infrastructure to promote tic stewardship in hospitals. Available at: https:// ship committee has been instrumental and disseminate best practices; (3) stan- www.cms.gov/Newsroom/MediaReleaseDatabase/ in standardizing the work and the adop- Fact-sheets/2016-Fact-sheets-items/2016-06-13.html. dardizing indications for use of the differ- Accessed 6 August 2016. tion of best practices. System-based ent antimicrobial classes promoting most 5. Leape LL. The checklist conundrum. N Engl J Med guidelines are shared with local ASPs narrow-spectrum agents; and (4) building 2014; 370:1063-4. with expectations for implementation. capacity for hospitals to achieve their Correspondence: Mohamad G. Fakih, Center for Antimicrobial By December 2015, each facility had an goals from local leadership buy-in to infra- Stewardship and Infection Prevention, Care Excellence, Ascen- identified pharmacist and physician to sion Health, 19251 Mack Ave, Suite 190, Grosse Pointe structuretodothe work. Woods, MI 48236 (mohamad.fakih@ascensionhealth.org). lead the work. In addition, all chief med- Assessing self-reported compliance ical officers are expected to garner physi- Clinical Infectious Diseases 2016;63(10):1391 with the core elements is a first step to © The Author 2016. Published by Oxford University Press for cian support for the ASPs. The local shed the light on US hospitals’ prepared- the Infectious Diseases Society of America. All rights reserved. pharmacy department leaders are also For permissions, e-mail journals.permissions@oup.com. DOI: ness to have ASPs. However, as Dr Lucian 10.1093/cid/ciw596 accountable for dashboards addressing ap- Leape thoughtfully stated, “It is not the propriate antibiotic use, updated monthly. act of ticking off a checklist that reduces To build capacity for smaller hospitals, we complications, but performance of have regional antimicrobial stewardship ex- the actions it calls for” [5]. Our efforts perts to provide support. We currently have need to build on the coalitions from 150 pharmacists enlisted in formal Web- healthcare systems, specialty societies, pa- based education in antimicrobial steward- tient advocacy groups, and the CDC to ship through the Society of Infectious change our national culture to one that Diseases Pharmacists. recognizes the risk of inappropriate anti- We continue to enhance the use microbial use and promotes stewardship of electronic clinical decision support as a critical patient safety matter. software to help pharmacists prospective- ly monitor antibiotic use and test results Note to facilitate their interventions. Finally, Potential conflicts of interest. All authors: we are incorporating best practices into No reported conflicts. All authors have submitted the electronic medical records to help the ICMJE Form for Disclosure of Potential CORRESPONDENCE � CID 2016:63 (15 November) � 1391 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Clinical Infectious Diseases Oxford University Press

Health Systems Can Play a Pivotal Role in Supporting Antimicrobial Stewardship

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Publisher
Oxford University Press
Copyright
The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com
ISSN
1058-4838
eISSN
1537-6591
DOI
10.1093/cid/ciw596
Publisher site
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Abstract

Clinical Infectious Diseases C O RRESP O NDEN CE Health Systems Can Play a Pivotal Conflicts of Interest. Conflicts that the editors guide clinicians in testing and treatment. Role in Supporting Antimicrobial consider relevant to the content of the manu- We continue to partner with the CDC to Stewardship script have been disclosed. submit data through the antimicrobial TO THE EDITOR—We read with great inter- Mohamad G. Fakih, Roy Guharoy, Ann Hendrich, and use and resistance module so we can Ziad Haydar est the results of the National Healthcare benchmark against other facilities and Care Excellence, Ascension Health, St Louis, Missouri Safety Network survey evaluating the identify potential opportunities for countrywide implementation of the Cen- improvement. References ters of Disease Control and Prevention We are ready to comply with the Joint 1. Pollack LA, van Santen KL, Weiner LM, Dudeck MA, (CDC) antimicrobial stewardship core Commission Standards [3] effective Edwards JR, Srinivasan A. Antibiotic stewardship elements [1]. As the United States’ largest programs in U.S.: acute care hospitals: findings January 2017 and the Centers for Medi- from the 2014 National Healthcare Safety Network not-for-profit healthcare system with 141 care & Medicaid Services’ proposed annual hospital survey. Clin Infect Dis 2016; hospitals and serving 24 states, Ascension 63:443-9. conditions for participation [4]related 2. The White House. National action plan for combat- answered the call for commitment to the to antimicrobial stewardship. However, ing antibiotic-resistant bacteria, 2015. Available at: White House report on Combating Anti- https://www.whitehouse.gov/sites/default/files/docs/ what is more important is that we are see- national_action_plan_for_combating_antibotic- biotic-Resistant Bacteria (CARB) [2] and ing concrete improvements in antimicro- resistant_bacteria.pdf. Accessed 6 August 2016. pledged to align with the CARB goals 1 bial use. Over the last year, we have been 3. The Joint Commission. Prepublication requirements. and 2. We established facility-based anti- New antimicrobial stewardship standard. Available able to reduce systemic antibiotic use by at: https://www.jointcommission.org/prepublication_ microbial stewardship programs (ASPs) 8%. This has been accomplished by (1) standards_antimicrobial_stewardship_standard/. and incorporated the CDC core elements Accessed 6 August 2016. making antimicrobial stewardship a sys- 4. Centers for Medicare & Medicaid Services. CMS issues at all Ascension hospitals. At the national tem priority with full leadership support; proposed rule that prohibits discrimination, reduces level, our system antimicrobial steward- hospital-acquired conditions, and promotes antibio- (2) creating an infrastructure to promote tic stewardship in hospitals. Available at: https:// ship committee has been instrumental and disseminate best practices; (3) stan- www.cms.gov/Newsroom/MediaReleaseDatabase/ in standardizing the work and the adop- Fact-sheets/2016-Fact-sheets-items/2016-06-13.html. dardizing indications for use of the differ- Accessed 6 August 2016. tion of best practices. System-based ent antimicrobial classes promoting most 5. Leape LL. The checklist conundrum. N Engl J Med guidelines are shared with local ASPs narrow-spectrum agents; and (4) building 2014; 370:1063-4. with expectations for implementation. capacity for hospitals to achieve their Correspondence: Mohamad G. Fakih, Center for Antimicrobial By December 2015, each facility had an goals from local leadership buy-in to infra- Stewardship and Infection Prevention, Care Excellence, Ascen- identified pharmacist and physician to sion Health, 19251 Mack Ave, Suite 190, Grosse Pointe structuretodothe work. Woods, MI 48236 (mohamad.fakih@ascensionhealth.org). lead the work. In addition, all chief med- Assessing self-reported compliance ical officers are expected to garner physi- Clinical Infectious Diseases 2016;63(10):1391 with the core elements is a first step to © The Author 2016. Published by Oxford University Press for cian support for the ASPs. The local shed the light on US hospitals’ prepared- the Infectious Diseases Society of America. All rights reserved. pharmacy department leaders are also For permissions, e-mail journals.permissions@oup.com. DOI: ness to have ASPs. However, as Dr Lucian 10.1093/cid/ciw596 accountable for dashboards addressing ap- Leape thoughtfully stated, “It is not the propriate antibiotic use, updated monthly. act of ticking off a checklist that reduces To build capacity for smaller hospitals, we complications, but performance of have regional antimicrobial stewardship ex- the actions it calls for” [5]. Our efforts perts to provide support. We currently have need to build on the coalitions from 150 pharmacists enlisted in formal Web- healthcare systems, specialty societies, pa- based education in antimicrobial steward- tient advocacy groups, and the CDC to ship through the Society of Infectious change our national culture to one that Diseases Pharmacists. recognizes the risk of inappropriate anti- We continue to enhance the use microbial use and promotes stewardship of electronic clinical decision support as a critical patient safety matter. software to help pharmacists prospective- ly monitor antibiotic use and test results Note to facilitate their interventions. Finally, Potential conflicts of interest. All authors: we are incorporating best practices into No reported conflicts. All authors have submitted the electronic medical records to help the ICMJE Form for Disclosure of Potential CORRESPONDENCE � CID 2016:63 (15 November) � 1391

Journal

Clinical Infectious DiseasesOxford University Press

Published: Nov 15, 2016

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