CME/CE: Guidance on Implementing Antibiotic Stewardship

CME/CE: Guidance on Implementing Antibiotic Stewardship
Author Information (click to view)

Tamar Barlam, MD

Director, Antibiotic Stewardship Program
Boston Medical Center
Associate Professor of Medicine
Boston University Medical School

Tamar Barlam, MD, has indicated to Physician’s Weekly that she has no financial interests to disclose.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians and nurses.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Review key recommendations made in the latest guideline from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) on Implementing an antibiotic stewardship program.

Method of Participation(click to view)

Release Date: 12/22/2016

Expiration Date: 12/22/2017

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwDec06.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Physician Assistants

NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

 

Nursing

AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is awarded 0.5 contact hours.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Christopher Cole – Managing Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Tamar Barlam, MD
Discloses no financial relationships with pharmaceutical or medical product manufacturers:
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Tamar Barlam, MD (click to view)

Tamar Barlam, MD

Director, Antibiotic Stewardship Program
Boston Medical Center
Associate Professor of Medicine
Boston University Medical School

Tamar Barlam, MD, has indicated to Physician’s Weekly that she has no financial interests to disclose.

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Infectious disease experts have developed a guideline on implementing antibiotic stewardship programs. The document emphasizes the customization of interventions based on local needs and resources.
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As part of the National Action Plan for Combating Antibiotic-Resistant Bacteria, hospitals and healthcare systems have been called upon by the White House to implement antibiotic stewardship programs by 2020. The goal of the plan is to ensure the appropriate use of antibiotics and reduce the growing emergence of resistance.

A previous guideline on antibiotic stewardship was released in 2007 and focused on the development of programs rather than on specific evidence-based strategies that have been shown to be beneficial in ensuring that such programs are effective and sustainable. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) have recently published a new guideline in Clinical Infectious Diseases that emphasizes the use of various interventions depending on local resources, issues, and expertise.

 

The Foundation

In total, IDSA and SHEA issued 28 recommendations in the new guideline. All of these recommendations stand on their own, complete with a section of literature that supports the recommendation. The guideline was based on a review of hundreds of  stewardship-focused papers that examined different strategies, “We included new studies as much as possible,” says Tamar Barlam, MD, who co-authored the update with Sara Cosgrove, MD. “For example, several recent studies show that a shorter course of antibiotics appears to be just as effective as a longer course,” she says. “A shorter but equally effective course would theoretically provide less opportunity for side effects or the emergence of resistance.”

Dr. Barlam notes that the IDSA/SHEA writing committee started with a recommendation they feel should be the first step in running an antibiotic stewardship program. “Pre-authorization, prospective audit and feedback, or both interventions should be the first step to implementing antibiotic stewardship based on studies showing that these approaches are the foundation of effective programs,” she says (Table).

Preauthorization requires physicians to consult with a member of the antibiotic stewardship team before an antibiotic can be released for their patient, according to Dr. Barlam. “This ensures that some of the antibiotics used for multi-drug-resistant infections are protected and used appropriately,” she says. “It also provides an opportunity to educate the prescriber on appropriate antibiotic use.” Prospective audits and feedback involve assessing patients’ therapy 2 to 3 days after starting an antibiotic to determine if an opportunity exists to either stop the drug or refine the coverage. Combining preauthorization with prospective review helps ensure that the right drug is prescribed at the right time for the right diagnosis.

 

Universal Recommendations

Dr. Barlam explains that the IDSA/SHEA writing committee purposely avoided providing recommendations in a step-by-step fashion. “Different facilities can take different approaches depending on the resources of each facility, the expertise of its practitioners, and the level of support to provide stewardship,” she says. “The writing committee didn’t want to be too prescriptive. However, several recommendations can certainly be followed by almost any facility, such as changing from intravenous to oral drugs whenever appropriate. In addition, most facilities could develop treatment guidelines that are targeted to their unique patient population and on their baseline resistance patterns.” Dr. Barlam adds that the writing committee examined the literature from a practical perspective, through the lens of whether or not a program could actually implement a given strategy.

The IDSA/SHEA writing committee recommends against the use of didactic education alone in providing antibiotic stewardship. “Occasional grand rounds, speaking about antibiotics over lunch, or distributing brochures is not real stewardship,” says Dr. Barlam. “Greater efforts are necessary to improve prescribing and change practices. Antibiotic stewardship should be integrated into the facility’s culture, with infectious disease specialists guiding strategies that have been shown to work.”

Reducing the use of antibiotics associated with Clostridium difficile infection, using computerized clinician decision support if available and affordable, and implementing antibiotic “time outs” are among other recommendations made in the guideline. Additionally, clinicians and hospitals are urged to implement other strategies to encourage prescribers to perform routine reviews of antibiotic regimens.

 

A Big Responsibility

Individual prescribers should feel a responsibility to deescalate or stop any unnecessary antibiotics, according to Dr. Barlam. “Clinicians should understand that antibiotic resistance is not just an issue for society,” she says. “It’s a problem at the individual patient level. There are plenty of ways for clinicians to get involved with stewardship because there are so many different types of interventions. Ultimately, it is the responsibility of every prescriber to understand that how they prescribe antibiotics is an important matter and that they need to strive to prescribe them as appropriately as possible.”

Readings & Resources (click to view)

Barlam T, Cosgrove S, Abbo L, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51-e77. Available at http://cid.oxfordjournals.org/content/62/10/e51.

Fishman N. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33:322-327.

Dellit T, Owens R, McGowan J, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159-177.

Buising K, Thursky K, Robertson M, et al. Electronic antibiotic stewardship—reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting. J Antimicrob Chemother. 2008; 62:608-616.

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