Development and evolution of a 24-hour pharmacist-coordinated antimicrobial stewardship service in a community hospital.

Abstract

To the Editor: Community and teaching hospitals are implementing antimicrobial stewardship programs to improve antimicrobial use, optimize patient outcomes, minimize adverse effects, and reduce resistance.1,2 Reduction in health care costs may also be a benefi t of an antimicrobial stewardship program, as long as it does not negatively affect the patients.1,2 The Joint Commission Standard NPSG.07.03.01 requires every facility to implement evidence-based practices to prevent health care–associated infections due to multidrug-resistant organisms in acute care hospitals.3 One such practice is implementation of an antimicrobial stewardship program. Antimicrobial use can be improved in a number of ways, including the selection of antimicrobials, whenever possible, based upon a patient’s culture and sensitivity (C&S) report, timely de-escalation of therapy when feasible, antibiotic selection and dosing consistent with the indication, and assurance that the duration of therapy is suitable for the condition being treated.1 Effective antimicrobial stewardship services also incorporate the change in patients’ medications from intravenous (IV) to oral (PO) routes when appropriate.1,4 Ongoing education to all health care providers, including clinical pharmacists, nurses, physicians, physician assistants, and nurse practitioners, is also a critical component of any successful antimicrobial stewardship program.1,2 Community hospitals often struggle with the implementation and maintenance of antimicrobial stewardship programs because of limited staffing. Thus, a workable alternative is needed when a full-time team devoted solely to antimicrobial stewardship is not economically feasible. The following describes a novel approach to implementing a model 24/7 pharmacist-coordinated antimicrobial stewardship service in a community hospital. As in any antimicrobial stewardship program, physician, staff, and administration support was fi rst obtained. After policies and procedures were developed and implemented, staff were trained. A multidisciplinary team was identifi ed to provide guidance and direction to the overall service and regularly scheduled meetings were initiated. After the program was implemented, there was ongoing monitoring and auditing by the multidisciplinary team, as well as constant surveillance of the literature to keep up with best practices. The fi rst step in the development of the 24/7 pharmacist-coordinated service was to gain physician, staff, and administrative buy-in and support. This was absolutely essential for success.1 Multiple presentations to administration and physicians at meetings such as the Medical Executive Committee (MEC) and/or the Pharmacy, Nutrition, and Therapeutics Committee (PNT) by infectious disease physicians and one-on-one discussions with primary prescribers laid the groundwork for the antimicrobial stewardship program. The presentations provided information regarding the overuse of antibiotics in hospitals, the reduction of potential antimicrobial resistance, and the rationale for establishing the antimicrobial stewardship committee. Arguments for the program included discussions of The Joint Commission’s national patient safety goal number 07.03.01 regarding multidrug-resistant organisms, the facilityspecifi c antibiotic resistance trends, and potential benefi ts an antimicrobial stewardship team could