Clinical Laboratories and Pharmacies Scramble to Be Ready for the Era of Hospital Antimicrobial Stewardship Programs That Starts on January 1, 2017

All hospital laboratories will be part of these programs, and it is an opportunity for medical laboratory professionals to deliver considerable value, as hospitals take steps to improve the utilization of antibiotics

Clinical laboratories and pharmacies in the nation’s hospitals and health systems have a huge opportunity to deliver substantial value in patient care. That’s because, at the start of 2017, hospitals must put effective antimicrobial stewardship programs (ASPs) in place to meet the new accreditation requirements of Medicare and The Joint Commission.

Overuse and inappropriate use of antibiotics is now considered one of the biggest problems in medicine. “Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” stated Tom Frieden, MD, MPH, Director, Centers for Disease Control and Prevention (CDC) and Administrator, Agency for Toxic Substances and Disease Registry (ATSDR), in a press release issued by the CDC last May. “Losing these antibiotics would undermine our ability to treat patients [who have] deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”

Much publicity is devoted to the rise of the increase of antibiotic-resistant organisms. In recognition of this problem, the Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (TJC), took steps to add antimicrobial stewardship program requirements to their respective hospital accreditation programs.

Antimicrobial Stewardship is a Major Opportunity for Clinical Laboratories

Clinical pathologists, microbiologists, and other medical laboratory scientists should seize this opportunity to demonstrate how effective use of lab tests can deliver improved patient outcomes, dramatically slash the overall cost per episode of care, and make gains in the effort to reduce antibiotic-resistant strains of bacteria.

Laboratory professionals are already on the front lines of every hospital’s infection control program. Since Medicare stopped paying for hospital-acquired infections (HAIs) in 2008, hospital labs have provided the necessary diagnostic tests to help clinicians identify patients with infections. These tests are used to track the transmission of infections from patient to patient within the hospital, and to identify the specific infectious agents to help physicians determine the antibiotics that would be most effective in treating these patients.

Since increased effort to manage HAIs has been going on for almost a decade already, what changes when every hospital must maintain an ASP as part of its Medicare and TJC accreditation requirements? Antimicrobial stewardship programs can only achieve optimal success when the microbiologists and clinical lab professionals leave their labs to collaborate daily with pharmacists, physicians, and nurses. And close interaction between the medical laboratory and pharmacy is already recognized as a critical success factor.

Hospital Labs Will Want to Collaborate, Consult with Clinicians, Pharmacists

This will be a big shift in thinking for the microbiology departments and molecular diagnostics labs in hospitals throughout the nation. Daily, some members of the lab team will be outside the lab working with pharmacists and physicians. It will include participating in daily rounds. Although this is a major change for lab professionals who have been comfortable within the confines of their laboratories producing timely and accurate lab test results, it will also bring the rewards that come from direct involvement in patient care.

To help hospital labs and hospital pharmacies understand how to organize and operate a highly-effective antimicrobial stewardship program, Dark Daily has organized a special webinar, “‘Big Bang’ of Antimicrobial Stewardship Programs Comes to All Hospitals on January 1: What Labs, Pharmacies, and Clinicians Must Do Collaboratively to Meet New Medicare and TJC Requirements.” It takes place on Wednesday, November 16, at 1 PM Eastern.

During this webinar, you will hear from experts at two different hospital organizations. First to speak is Mike Broyles, BSPharm, PharmD, Director of Pharmacy and Laboratory Services at Five Rivers Medical Center, in Pocahontas, Arkansas. His hospital’s ASP is now in its fourth year of operation and has attracted national attention for its successes in caring for patients while improving the appropriate use of antibiotics. Of course, the cost savings have been significant and the clinical laboratory has been a major contributor.

Your second expert to speak is Monique Dodd, PharmD, PhC, MLS(ASCP)CM. She is the Enterprise Clinical Solutions Specialist for TriCore Reference Laboratories in Albuquerque, New Mexico. Because Dodd is trained in both pharmacy and as a medical laboratory scientist, her perspectives on establishing an effective antimicrobial stewardship program will be highly relevant to microbiologists, pathologists, and clinical laboratory scientists participating in this special webinar.

Equally notable is that TriCore is an independent clinical laboratory that is owned by two major health systems. Dodd will discuss how the ASP teams at the hospitals are:

• Establishing clinical priorities;

• Working to integrate laboratory and pharmacy data into the Epic electronic health record (EHR) systems in use at the hospitals; and

• Developing algorithms designed to improve how antibiotics are utilized.

This will be essential information for pharmacists, pathologists, and medical laboratory professionals working in multi-hospital health systems who are working to standardize care protocols and informatics tools across the different hospitals in their health systems.

Webinar topics to be discussed include:

• Standards of performance that comprise this new Medication Management standard;

• How to improve utilization of clinical laboratory tests, including the best ways to use procalcitonin;

• Coordinating the different disciplines, identifying accountability and competencies, and the right resources for success;

• Informatics capabilities that will optimize your program’s success, including developing interpretive reports and working with the Epic EHR;

• Developing protocols for bacterial and viral infections, along with guidelines for prescribing antibiotics and antivirals; and

• Analyzing the impact of the ASP program to your organization.

Because Five Rivers Medical Center has operated its antimicrobial stewardship program for four years, it has solid data on how outcomes improved, along with important lessons to share about how every hospital’s ASP can be structured to ensure major successes coming out of the gate. Three examples show the power of the information to be shared at this webinar (the study included 967 patients pre-implementation and 1,167 patients post-implementation):

• 42% Reduction in Antimicrobial Days of Therapy: Pre-implementation, it was an average of 16.43 days of therapy. After implementation that fell to 9.52 days of therapy.

• 47.2% Reduction in 30-day Readmissions: Pre-implementation, it was an average of 18%. After implementation it decreased to 9.5%.

• 64.6% Reduction in C. difficile Infections: C. difficile infection rate was 9.5% pre-implementation. It declined to 0.9% post-implementation.

In her role as Enterprise Clinical Solutions Specialist at TriCore Reference Laboratories, Dodd is involved in three different clinical domains. She works with the ASP teams at both University of New Mexico Health and Presbyterian Health Services. In addition, she coordinates related activities with office-based physicians and public health labs in New Mexico.

Dodd will report on efforts to develop interpretive reports for physicians that bring in the information from the pharmacy and the clinical laboratory, so as to best guide decisions about which antibiotics and antivirals may be most appropriate for patients. It is the goal of the ASP programs at these health systems to make this information available within their respective Epic EHRs, so physicians have easy and quick access to these reports.

Act now to guarantee your place at this important webinar. You can register HERE  (or copy and paste this URL into your browser: https://ddaily.wpengine.com/audio-conferences/big-bang-of-antimicrobial-stewardship-programs-comes-to-all-hospitals-on-january-1-what-labs-pharmacies-and-clinicians-must-do-collaboratively-to-meet-new-medicare-and-tjc-require-1116.)

 

Related Information:

For information and to register: ‘Big Bang’ of Antimicrobial Stewardship Programs Comes to All Hospitals on January 1: What Labs, Pharmacies, and Clinicians Must Do Collaboratively to Meet New Medicare and TJC Requirements

CMS’ Proposed Rule for Hospitals: Reduce Antibiotic Use or Exit Medicare

Core Elements of Hospital Antibiotic Stewardship Programs

Approved: New Antimicrobial Stewardship Standard

Prepublication Standards—New Antimicrobial Stewardship Standard

CDC: 1 In 3 Antibiotic Prescriptions Unnecessary