Antimicrobial Stewardship: Program Implementation Success And

Antimicrobial Stewardship: Program Implementation Success and Lessons from the Joint Commission October 6, 2017 Marsha Crader, PharmD; Mandy Langston, PharmD; Megan Patch, MS, PharmD, BCPS; Elizabeth Smith, PharmD; Sarah Cochran, PharmD.

1. Objectives: a. Pharmacist a.i. Summarize the core elements of a hospital antimicrobial stewardship program. a.ii. Describe the Joint Commission antimicrobial stewardship medication management standard, elements of performance, and recent survey experiences. a.iii. Review antimicrobial stewardship quality improvement strategies from Arkansas hospitals of various sizes. a.iv. Discuss successes and obstacles of implementing and maintaining an antimicrobial stewardship program. b. Technician b.i. Explore the aspects of a hospital antimicrobial stewardship program b.ii. Describe The Joint Commission’s standards of medication management and performance b.iii. Discuss the improvement strategies Arkansas hospitals are taking to improve antimicrobial stewardship b.iv. Examine the successes and challenges experienced surrounding an antimicrobial stewardship program

2. Antimicrobial stewardship introduction a. ISDA Antimicrobial Stewardship Recommendations b. Core elements of antimicrobial stewardship programs c. Proposed CMS requirements of participation d. Joint Commission medication management standard MM.09.01.01 e. Joint Commission FAQs on MM.09.01.01

3. Joint Commission experiences a. Baptist Health Medical Center - North Little Rock b. Baptist Health Medical Center - Heber Springs c. Baptist Health Medical Center - Arkadelphia

4. Hospital experiences a. Baptist Health a.i. Daptomycin cost savings a.ii. Antibiogram redesign and restructure a.iii. Protocol standardization a.iii.1. Vancomycin protocol standardization a.iii.2. Aminoglycoside protocol b. St. Benard’s Medical Center b.i. Treatment of Extended Spectrum Beta-Lactamases (ESBLs) b.i.1. Pharmacy Intervention Examples b.ii. Decreasing vancomycin usage b.ii.1. Physician Time-out intervention b.ii.2. Initial MRSA Nasal Screen Literature b.ii.3. PCR Gram (+) Blood Culture Testing b.ii.4. Success b.ii.5. Barriers b.ii.6. Lessons Learned c. Baxter Regional Medical Center c.i. Informal stewardship c.ii. Meropenem prescribing evaluation c.ii.1. Findings c.ii.2. Interventions c.iii. Pneumonia Anti- MRSA DOT reduction c.iv. Stewardship committee formation d. Stone County Medical Center d.i. Limitations for critical access hospital d.ii. Experiential approach d.iii. Stewardship Projects d.iii.1. Community Effort d.iii.2. Success/barriers and lessons learned d.iv. Antimicrobial susceptibility report d.v. Education and resources for clinicians d.v.1. Physicians/APNs d.v.2. Nursing d.v.3. Community Healthcare Teams d.v.4. Patients d.v.5. Board Members d.vi. Community goals for antimicrobial stewardship d.vi.1. Retail Pharmacy d.vi.2. Family Practice Clinics d.vi.3. Nursing Home