Resistance to antibiotics is one of the greatest modern health threats, according to the World Health Organization (WHO), with doctors fighting to treat an increasing number of diseases previously easily cured with a dose of antibiotics. Thanks to overuse and overprescribing of antibiotics, “bad” bacteria can mutate to become “superbugs,” or antibiotic- resistant diseases. And the result for patients is: longer illnesses, longer hospital stays, and a greater mortality risk.
Recognizing the dangers caused by antimicrobial resistance, the Centers for Medicare & Medicaid Services (CMS) initiated an Antibiotic Stewardship Programs (ASP) in hospitals across the U.S., included in Phase II of a Final Rule issued October 4, 2016. In a live webinar with ProfEdOnDemand, medical legal consultant Sue Dill Calloway discusses what every hospital should know about CMS’s new ASP requirements, as well as other changes to the hospital conditions of participation (CoP), including medical records, patient rights, and restraint and seclusion.
Feds Look to You to Reverse the Trend
Antimicrobial resistance is nothing new, with studies published as far back as 1998 warning that the global society’s over-dependence on antibiotics is causing an increase in superbugs. If proper action is not taken to curb antimicrobial resistance, then by 2050, drug-resistant infections could be the cause of 10 million deaths per year worldwide, says The Review on Antimicrobial Resistance.
Further attention to this issue led President Obama to issue an executive order in 2014 to create the Task Force for Combating Antibiotic-Resistant Bacteria. The order instructed the Department of Health and Human Services (HHS) to implement antibiotic stewardship programs in healthcare facilities. A year later, President Obama also issued the National Action Plan for Combating Antibiotic-Resistant Bacteria. Adhering to these efforts, the Joint Commission issued Medication Management (MM) standard, MM.09.01.01, which applies to hospitals, nursing facilities and critical care hospitals alike.
Effective since January 1 of last year, the MM standard outlines qualifications for a successful ASP, which include:
- Strong leadership which prioritizes antimicrobial stewardship
- Education and training for staff, and
- Education for patients and patients’ family members alike.
ASP Partners: Physicians & Pharmacy
The numbers from the Center for Disease Control (CDC) are troubling: An estimated 30 percent of antibiotics prescribed to outpatients are unnecessary. As a result, bacteria have more of a chance to develop resistance and cause increasingly serious health and financial issues in the U.S. healthcare system. CMS initiated its ASP to support the MM standard and follow the 2014 Executive Order.
A successful ASP, according to CMS, includes seven elements:
- Leadership commitment
- Accountability
- Drug Expertise
- Action
- Tracking
- Reporting
- Education
CMS recommends that a physician and pharmacy leader together co-lead each ASP. Overall, a multidisciplinary approach is ideal, with input from laboratory staff, IT staff, nurses, clinicians and others. Each department has unique knowledge on the use and dosage of antibiotics, and, by working together, a much fuller and more accurate picture of what can be improved will be available, says CMS.
In addition to the above seven elements, CMS requires that the program:
- Include an active agenda with evidence-based use of antibiotics.
- Document overall improvements in overall antibiotic resistance and specifically in the reduction of Clostridium difficile infection (CDI).
- Observe nationally recognized guidelines for proper antibiotic use and dosage.
By following a successful ASP plan, hospitals should start to see improvement in quality of patient care and safety, improved treatment rates, reduction of CDI and overall antibiotic resistance, and cost savings (most notably from reduced patient stays and treatment length).
Halting Superbugs is a Team Compliance Effort
It’s clear that the feds are taking antimicrobial resistance seriously—and they expect you and your healthcare organizations to be on the frontlines of a solution. Careful and thoughtful implementation of ASPs can reduce unnecessary exposure to antibiotics—but only if all stakeholders are on board. These standard-of-care changes will affect everyone—pharmacists, infection preventionists, risk management employees and anyone involved in implementing hospital CoPs, says Calloway. So be sure your entire hospital staff is informed—and equipped to comply.
