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Antimicrobial Stewardship (AMS) at Mercy Medical Center

There was a new Joint Commission standard that went into effect this year regarding required education about antimicrobial stewardship for all staff including LIPs.  

Antibiogram & Antibiotic Quick Reference

What is AMS?

  • “Coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents”1
  • Goal is to ensure that all patients are receiving the right drug at the right dose and for the right duration

 Why is AMS important?

  • Antimicrobials are not harmless. Up to 30-50% of antimicrobials used in acute care hospitals are unnecessary or inappropriate (e.g. wrong drug, dose, or duration).2
    • Acceleration of rate of resistance
    • Selection of pathogenic organisms, such as Clostridium difficile
    • Toxicity
  • Antimicrobial resistance is an increasing global threat
    • At least 2 million infected with resistant bacteria each year in the U.S. and at least 23,000 die3
  • A decrease in the number of new antimicrobials being developed and approved
  • Joint Commission AMS Standards became effective January 2017

 What is Mercy doing to practice AMS?

  • Multidisciplinary AMS Committee
  • ID physician consult service and ID/AMS pharmacist
  • Reporting antimicrobial use and resistance data, including a yearly antibiogram
  • Order set review/implementation
  • Policies/protocols (examples: piperacillin/tazobactam extended infusion, meropenem dose optimization, IV to PO, renal dosing, antibiotic restriction)
  • Antimicrobial timeout (trigger tool to stop and assess therapy)
  • Research projects and medication use evaluations
  • Rapid diagnostics (examples: blood culture PCR panel, MALDI-TOF)
  • Education

 What can providers do to practice AMS?

  • Utilize AMS pharmacy services
  • Choose the correct indication and dose when ordering antimicrobials
  • Refer to the antibiogram for empiric therapy
  • Review appropriateness of empiric antimicrobials after the initial 48 hours
  • Ensure appropriate use of protected antibiotics (broad-spectrum, active against resistant pathogens)
  • De-escalate therapy
  • Apply stop dates to orders
  • Assess allergies (especially β-lactam allergy)
  • IV to PO conversion
  • Ensure correct duration of therapy for discharge antibiotics (take inpatient duration into account)
  • Use evidence based/guideline recommended treatments and durations
  • Decrease C. diff factors (decrease PPI usage, use lower risk antibiotics)

 Questions? AMS Pharmacist: Megan Bernabe, PharmD, MPH, BCPS; mbernabe@mercycare.org; 319-221-8850

 

References: 1SHEA/IDSA/PIDS Policy Statement on AMS. Infect Control Hosp Epidemiol. 2012; 2https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6309a4.htm; 3https://www.cdc.gov/drugresistance/about.html

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