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NQF: Antibiotics 'Playbook' to Synch with Accreditation Standards

By HealthLeaders Media News  
   May 26, 2016

In addition to aligning with coming standards from The Joint Commission, the document also promises to help hospitals follow existing guidelines from CMS and the CDC.

A new "playbook" on the appropriate use of antibiotics aims to help hospitals reduce rates of drug-resistant infections and prepare for new standards to be implemented in 2017 by The Joint Commission.

The playbook was released Wednesday by a group convened through the National Quality Forum's National Quality Partners and was the subject of a telephone briefing with media in the afternoon.

In addition to aligning with Joint Commission coming standards, the document also promises to help hospitals follow existing guidelines from the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention.  

"We know antibiotics are critically important drugs when we need them," said Arjun Srinivasan, MD, of the CDC, during an online release of the document. He is associate director for healthcare-associated infection prevention programs in the division of healthcare quality promotion. 

"At the same time, we know that they are often times used when they are not needed and sometimes, even when they are needed, they are use incorrectly." 

Srinivasan is co-chair of the group that generated the document. Framed by a committee that included patient advocates, infectious disease specialists, pharmacists, and hospital representatives, the effort was designed to give hospitals guidance on how to adopt guidelines issued by the CDC in 2014.

An estimated 30% to 50% of antibiotics prescribed in hospitals are unnecessary or inappropriate. That has led to increasing resistance and difficult to treat so-called super bugs.  The agency received positive feedback on that plan, but hospitals asked for help with implementing the recommendations, Srinivasan said.

"Misuse occurs in healthcare settings for a variety of reasons, including use of antibiotics when not needed, continued treatment when no longer necessary, wrong dose, use of broad-spectrum agents to treat very susceptible bacteria, and wrong antibiotic to treat an infection," the document notes.

Ed Septimus, MD, the director of infection prevention at Hospital Corporation of America (HCA) co-chairs the group that produced the guidelines.

He emphasized that the playbook was designed in a way that will allow each hospital to customize a program to its size, patient population and other needs.

"We hope that this document will enable success on a local level, because we all know that local execution is what really matters," Septimus said.    

5 Elements of Antibiotic Stewardship

The playbook is broken up into five "core elements" considered key to a successful stewardship program: 

  1. Leadership commitment
  2. Accountability
  3. Drug expertise
  4. Action
  5. Tracking

Each section offers examples of implementation, a list of potential barriers and links to resources.

Under the leadership commitment heading, the playbook notes that the effort must have commitment and financial support from hospital boards and executive teams. 

Potential barriers to getting leadership on board include lack of C-suite awareness of the issue, as well as competing priorities or "commitment fatigue."  

The document suggests that hospital leadership consider the effort as part of a health system's quality improvement and patient safety programs.  It also notes that stewardship effort will help hospitals maintain accreditation.

Margaret Van Amringe, vice president for public policy at The Joint Commission, said the accreditation body incorporated the CDC guideline into the "Antimicrobial Stewardship Standard" that will be published in July and will go into effect sometime during the first quarter of 2017.  

The Joint Commission will be looking at whether hospital leaders are behind the effort and have committed resources to it.

Articulating the effort in language that resonates in the C-suite is important, said Kristi Kuper, a pharmacist and clinical manager with Vizient, the purchasing and performance improvement company formed by last year's merger of the non-profit hospitals of the VHA and the academic medical centers of UHC.

"Some of the most successful programs I've developed started with a good business plan," she said.

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