A CMS proposed rule released in June 2016 will require hospitals and critical access hospitals to implement antibiotic stewardship programs in order to participate in CMS programs, among other changes.
While the rule is applicable to hospitals only at this point, it does have some implications for ambulatory surgery centers. Antibiotic resistance, or the ability of microbes to resist the effects of drugs, is a problem at all healthcare facilities, and it is not going to go away on its own. Around 2.04 million people fall ill due to antibiotic resistance every year in the United States, according to the Centers for Disease Control and Prevention.
"This is first time there has been federal direction on this issue," says Marcia Patrick, MSN, RN, CIC, consultant and educator in infection prevention and control and a surveyor for Accreditation Association for Ambulatory Health Care. "CMS holds the purse strings of healthcare facilities, and so if a facility accepts federal money, they will have to comply. Also, hospitals will have to be aware of facilities in which their patients receive care, which includes ASCs and nursing homes."
Successfully implementing antibiotic stewardship involves changing the behavior of several different people. Here are four best tips for implementing a program addressing this issue at your ASC, from Ms. Patrick:
1. Educate patients. Make sure your patients are educated about their medications. For example, make sure they know how often they have to take the medicine and warn them against skipping a dose. Stopping an antibiotic course before it is over can cause resistance.
"It's all about giving the right dose at the right time for the right duration," says Ms. Patrick. "Follow your own professional guidelines. Set the doses based on the patient's weight. We also know that the timing of the antibiotic is critical. For example some longer surgeries require additional doses of antibiotics."
At this point the CMS draft rule does not include ASCs specifically but it is important to practice good antibiotic stewardship and infection control practices.
2. Implement a quality improvement program. Antibiotic stewardship goes hand-in-hand with infection control, says Ms. Patrick. Both need to be a part of the healthcare facility's larger quality improvement program.
3. Add staff members. New programs and initiatives often require additional resources, including additional staff members trained in infection control best practices and antibiotic stewardship, notes Ms. Patrick.
4. Close the loop. It is important to have clinical and administrative staff members on the same page with regard to antibiotic stewardship. Physicians and infection preventionists gather data on the infections affecting their patients. Encourage physicians to work with other members of staff and share the data to improve coordination of antibiotic stewardship. Support from the top is essential for this initiative.
"Ultimately, good antibiotic stewardship, infection control and quality improvement programs help a facility maintain its accreditation. Most importantly, they protect patients and result in optimal outcomes for them" says Ms. Patrick.
