Antibiotic stewardship mandate demands better leadership and training, experts stress

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Antibiotic stewardship mandate demands better leadership and training, experts stress
Antibiotic stewardship mandate demands better leadership and training, experts stress

ST. LOUIS — The second phase of the Centers for Medicare & Medicaid Services' new requirements of participation for nursing homes will take effect Nov. 28, and with it comes the requirement that facilities must have an antibiotic stewardship program in place.

But where should providers start in order to ensure antibiotic stewardship success? Look up, one expert says.

“It probably doesn't surprise you that leadership is the top,” said Bonnie Wood, CNHA and the COO for Covenant Health Network, on Monday at the American College of Health Care Administrator's annual convocation. “Any time that we create focus around a program as administrators, executive directors, CEOs ... when we create that focus around a program it gets more attention from our staff.”

Wood shared seven core elements of a successful antibiotic stewardship program with attendees.

Providers should make sure that the medical director, director of nursing, infection preventionist, consulting pharmacist and the state health department are all involved. Another key person to identify is an antibiotic stewardship champion, who “has interest in it, really understands the program and really wants to make it work,” Wood said.

Rounding out the list of core elements are:

•  Accountability, or having all the “key players” involved

•  Drug expertise

•  Taking action, including baseline assessments, updating policies and taking a hard look at prescribing practice

•  Tracking and reporting how and why antibiotics are prescribed

•  Education for the senior team, clinicians, all staff, residents and families

Education is important, added Peter Patterson, M.D., MBA, medical director and consultant for Covenant, since antibiotic stewardship efforts are “going to be much more team-based.”

Patterson also offered up three “key ideas” for stewardship protocol: understanding the root cause of antibiotic resistance, syndrome-focused prescribing audit and feedback, and using an alternate pathway, such as observation, for handling common prescribing scenarios. Overall, creating an antibiotic stewardship program and combating the spread of antibiotic resistance is a transition away from “just in case” prescribing, Patterson said.

“We're really careful to not give the impression that we're doing something wrong. If you want to get things moving in a transition you have to honor where you're starting from,” Peterson said. “It's the first stage of the rocket. What has to happen for the second stage to engage? The first stage has to disengage.”

More than 220 long-term care professionals gathered in St. Louis for ACHCA's 51st Annual Convocation & Exposition. The event continues through Wednesday.