Antibiotic Stewardship: Leveraging ID Pharmacists, New Technologies & A Look Toward 2020
In observance of Antibiotic Awareness Week, we spoke with PipelineRx’s antimicrobial stewardship expert, Aviva Bodek, PharmD, BCPS. Dr. Bodek’s expertise in antibiotic use dates back to her time working as a critical care clinical pharmacist, where she witnessed the impact of infection control on patient outcomes. In the Q&A below, Dr. Bodek highlights what you should know about stewardship – including where we are with programs today, how pharmacists are vital to successful antibiotic stewardship, and where we can expect to go in 2020 and beyond.
Q: This week is Antibiotic Awareness Week. How long has this issue been a focus?
A: Antibiotic stewardship has been an important topic in the industry for quite some time now. In 2016, CMS began requiring nursing facilities to have a stewardship program in response to widespread misuse of antibiotics in such settings. Then, in 2017, the Joint Commission expanded efforts by issuing standards for acute-care hospitals, critical access hospitals and nursing homes to have an antibiotic stewardship program to maintain their accreditation. As of this past June, the requirement also pertains to ambulatory care centers.
Q: Have these regulations had an impact?
A: The Joint Commission standard issued in 2017 really got the ball rolling. Since then, a large number of facilities have adopted antimicrobial stewardship programs, or ASPs. But it’s the new CMS rule requiring all acute-care and critical access hospitals that participate in Medicare or Medicaid develop and implement an antibiotic stewardship program by March 30, 2020 that has put the topic back in the spotlight.
Q: What is the goal of an Antimicrobial Stewardship Program?
A: The fact is that 30% of all antibiotics prescribed in the U.S. are either unnecessary or inappropriate and this has led to antibiotic resistance and the rise of superbugs, not to mention excessive cost. The goal of an ASP is to optimize clinical outcomes through appropriate antibiotic use. Additional benefits include minimizing unintended consequences, improving susceptibility rates to antimicrobials, while maximizing resource utilization. Whether that’s moving from broad spectrum to narrow spectrum therapy once culture results are available, adjusting the dose and length of therapy, or eliminating unnecessary antibiotics from the beginning — the benefits are truly extensive.
Q: What is the role of a pharmacist in antibiotic stewardship and how is the role evolving?
A: ASP programs require participation from multiple disciplines, including infectious disease physicians, general practitioners, infection control, nursing, environmental services, laboratory, and, of course, pharmacy. Together, the team must determine the program’s objectives. Pharmacists are particularly critical to this effort as the medication experts. The pharmacist’s role in ASP traditionally includes dose optimization, identification of unnecessary duplicate therapy, detection and prevention of antibiotic-related drug-drug interactions, tailoring therapy based on culture results, and switching from intravenous to oral antibiotic therapy. This has evolved into more of a leadership role with pharmacists overseeing the entire program, from analyzing performance metrics and tracking trends, to providing education.
Q: With all of the benefits of stewardship programs, why has it taken regulatory requirements to spur implementation?
A: While these programs provide an enormous amount of cost savings in addition to significant patient care benefits, they don’t necessarily generate revenue. As such, the benefits of cost avoidance can be easily undervalued or overlooked. However, as we face the serious threat of antibiotic resistance, stewardship is no longer optional and regulatory requirements simply elevate the priority.
Q: Looking into 2020, what do you think these new CMS requirements will accomplish?
A: Organizations that have been laying the groundwork will begin to see their programs come to fruition. However, there will be challenges, specifically when it comes to meeting the new mandatory standards. Many smaller facilities don’t currently have specially trained infectious disease (ID) pharmacists to spearhead these initiatives.
Q: How will facilities move past these challenges?
A: Technology can assist by making processes more efficient. Smart systems, like the one we developed at PipelineRx, identify patients and alert the pharmacist enabling them to rapidly intervene. Dynamic reporting allows the pharmacists to more easily identify opportunities for provider education and target specific prescribing habits. This technology can be used by onsite staff or with support from our remote team of infectious disease specialists who can also assist with program structure, reporting, and education. Solutions like these can really help get programs up and moving before the necessary deadline.
Q: What would you say to pharmacists or pharmacy students interested in this growing area?
A: I would say get involved! The Society of Infectious Diseases Pharmacists is a good organization to join and get regular updates from. Doing so would keep you in touch with the latest information on antimicrobial stewardship as it relates to pharmacists and upcoming educational programs. This expanding field is a great opportunity for pharmacists.
Aviva Bodek, PharmD, BCPS has been with PipelineRx for 8 years and currently serves as the Director of Clinical Services. Dr. Bodek earned her Doctor of Pharmacy degree from the University at Buffalo School of Pharmacy and Pharmaceutical Sciences. Upon graduation, she practiced as a clinical pharmacist at Rochester General Hospital. She then took on the role of Clinical Coordinator and Critical Care/Emergency Medicine Clinical Pharmacy Specialist at Thompson Health, a University of Rochester Medical Center Affiliate. She has a special interest in and lectures on topics including infectious disease.