The Centers for Disease Control and Prevention (CDC) estimates that between 20 to 50 percent of all antibiotics prescribed in U.S. acute care hospitals are unnecessary or used inappropriately. In an effort to curb rising mortality rates and antimicrobial resistance, the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs recommends that pharmacists and physicians with formal training in infectious diseases (ID) and/or antibiotic stewardship spearhead the development and management of antimicrobial stewardship programs (ASP).
Despite the CDC’s recommendation, numerous facilities, particularly small community hospitals, face resource challenges associated with ASP implementation and employment of full-time ID physicians and pharmacists. Without the right expertise in place, hospitals and health systems risk compliance issues associated with accreditation requirements and evolving federal mandates that now require formal ASPs to address inappropriate prescribing and general antimicrobial use practices.
Limited ID Pharmacists
Although the need for clinical ID pharmacists is increasingly vital for countless healthcare environments across the nation, there is an alarming shortage of professionals with expertise in infectious diseases and antimicrobial stewardship. A scarcity of postgraduate training opportunities in these areas exacerbates the situation. Due to this insufficiency, community hospitals encounter even greater difficulty in employing pharmacists with specializations in these areas, as well as developing and maintaining highly effective ASPs.
Pharmacist-Led ASP without ID Physician Support
In addition to scarce pharmacy expertise, many community hospitals lack the resources to employ ID physicians. As such, the responsibility for overseeing ASPs is often left to pharmacists and pharmacy departments. Although guidelines are available for non-ID providers, most descriptions of ASP implementation focus on use of ID physicians as part of the antimicrobial stewardship team.
Despite these challenges, one study reveals that high-performing ASP initiatives are possible when led by a full-time pharmacist with training in antimicrobial stewardship. Along with the support of providers and an AMS committee, the program featured in the study lacked direct supervision of an ID physician. Educational modalities were provided to clinicians, and the initiative was formally rolled out. Ultimately, utilization of antimicrobials and expenditures significantly decreased despite the absence of an ID physician. No adverse outcomes were documented.
Investing in Clinical Decision Support
Pharmacy-led ASPs demonstrate improved outcomes, yet many community hospitals still lack the resources needed to acquire the support of pharmacists and physicians with ID-specific training. To empower non-ID pharmacists and staff to lead impactful ASPs, hospitals can invest in clinical surveillance and decision support software. These solutions aid in alleviating the challenges incurred when the expertise and oversight of ID-specialized providers are absent.
A real-time CDS surveillance solution, Sentri7, has been utilized by community hospitals to support non-ID pharmacists and medical staff to maintain highly successful ASPs. The Sentri7 AIM Alert content targets the key interventions recommended by SHEA/IDSA guidelines and supported by the CDC, such as prospective audits, de-escalation, antibiotic “timeouts,” and dose optimization. With a continuous editorial process that provides the most up-to-date clinical information paired with evidence-based alerts and recommendations for antimicrobial prescribing, the solution enables hospitals to operationalize evidence-based content for monitoring of patients by any and all pharmacists. Sentri7 has a proven track record of achieving clinical outcomes as well as cost reduction associated with antimicrobial expenditures, with one hospital documenting $250,000 in savings in the first six months, while ensuring optimal patient care and outcomes.