Abstract
The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial Stewardship (AMS) Program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.
Highlights
The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial Stewardship (AMS) Program
The analysis revealed that the academic medical center (AMC) model for AMS consistently outperformed consistently outperformed the community hospital AMS model (Figure 1)
It is important to note that these results are only from the first year after instituting the health6
Summary
CHI Health, a 14-hospital health system in Nebraska and southwestern Iowa, is comprised of one academic medical center (~300 beds), eight acute care community hospitals, ranging in average daily census of 10–200 patients each, and five critical access hospitals (25 beds or less). The pharmacists communicated these recommendations to the prescribing providers This program was implemented without any additional pharmacist resources or hours, and with minimal pharmacist training in infectious diseases. CUMC, the Creighton University Health Sciences affiliated teaching institution, with a Level 1 trauma service, had implemented its own AMS program in 2011. This program included a dedicated pharmacist FTE responsible for all AMS activities, and a partnership with the Creighton University Infectious Disease division for ID physician support. The remaining independent hospitals joined with the newly formed system in 2013 to form the regional health-system These hospitals had recently implemented independent antimicrobial stewardship programs, without additional ID trained pharmacist or ID trained provider resources.
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