Antimicrobial prescribing and stewardship is an imperative across all health care settings in light of nearly 23,000 annual U.S. mortalities related to antibiotic resistance. In recent years, the Centers for Disease Control and Prevention’s (CDC’s) Core Elements of Hospital Antimicrobial Stewardship Programs has been recognized as an industry best practice for improving the outlook. Expanding on those best practices, the government agency recently released the Core Elements of Outpatient Antibiotic Stewardship following the 2015 release of the Core Elements of Antibiotic Stewardship for Nursing Homes. The four elements of outpatient antibiotic stewardship include commitment, action for policy and practice, tracking and reporting, as well as education and expertise.
Approximately half of all outpatient antibiotic prescriptions are inappropriate, and at least 30 percent of all outpatient antibiotic prescriptions have been deemed unnecessary. Subject-matter experts aided in developing the four elements which include strategies and modifications based on evidence-based practices to prevent rapid community antibiotic resistance, reduce adverse drug events due to unnecessary utilization of antibiotics, and improve patient care and outcomes. The CDC recommends that outpatient clinicians and facility leaders implement at least one policy or practice centered around increasing proficiency of antibiotic prescribing, reporting and education.
Expanded Core Elements
Effective antimicrobial stewardship programs (ASPs) are founded on the commitment of all health care team members to appropriately prescribe antibiotics and adhere to antimicrobial stewardship initiatives. In order to demonstrate commitment, outpatient health care facilities can designate a single leader who is responsible for overseeing all antimicrobial stewardship activities and practices. Antimicrobial stewardship-related duties should also be included in staff members’ job descriptions to ensure transparency into the necessary time and resources required. By adhering to consistent patient messages and communication, antibiotic prescribing practices will improve along with set patient expectations.
Policy and Practice
Bringing outpatient antimicrobial stewardship initiatives to fruition requires that healthcare organizations address needed policy and practice changes. Providers can drill down into these areas by using evidence-based diagnostic criteria and treatment recommendations and delayed prescribing—or watchful—prescribing practices. Communication skills training among providers can improve patient understanding of antibiotic treatment. Requiring written justification in patient medical records helps to hold providers accountable and reduce inappropriate prescribing. To truly effect change, clinical decision support is vital to provide clinicians with accurate diagnoses and antibiotic recommendations.
Tracking and Reporting
Improved antimicrobial stewardship initiatives can be facilitated by tracking and reporting the rates at which clinicians and facilities prescribe antibiotics. By aggregating data, analyzing individual clinician prescription rates and percentage of visits, and providing individualized clinician feedback, overall antibiotic prescribing can be reduced. Feedback from clinicians aids in modifying stewardship interventions to better serve the patient population. Outpatient health care systems should utilize at least one antibiotic prescribing tracking and reporting system. Providers should alsoshare performance on quality measures and reduction goals that focus on antibiotic prescribing.
Educating clinicians, medical staff and patients on antimicrobial stewardship is vital to improving ASPs in outpatient environments. Patients and families should be educated on effective antibiotic utilization and potential harms of antibiotic treatment as well as provided with educational materials. Antimicrobial stewardship experts must also be accessible to clinicians as a reliable source.
Achieving High-Performing Antimicrobial Stewardship Programs
The release of the CDC’s Core Elements of Outpatient Antibiotic Stewardship is an important industry development to help reduce antimicrobial expenditures, adverse drug events and community-associated infections. Healthcare organizations increasingly find that clinical surveillance solutions notably help streamline the deployment and ongoing management of these elements.
Sentri7, a real-time CDS surveillance platform, overcomes challenges of manually aggregating, analyzing, and reporting antimicrobial prescribing practices. The solution incorporates process governance and surveillance technology to improve antimicrobial prescribing while delivering notable return-on-investment. Evidence-based guidelines and customized rules and alerts monitor patient medication and culture data. By integrating Sentri7 into outpatient settings, clinicians are better positioned to realize optimal clinical outcomes.