New Resources Aim to Simplify Stewardship Implementation

A finalized Joint Commission standard, along with proposed CMS regulations, place more emphasis on program leadership and providing resources for measurement and action.

New regulations released by CMS and The Joint Commission will place added pressure on hospitals to implement antibiotic stewardship programs in a much anticipated national effort to limit the spread of resistance.

In June, The Joint Commission finalized its medication management standards (MM.09.01.01), offering very few changes to the proposed rule that was released in November 2015. The finalized standards require hospitals to make antimicrobial stewardship “an organizational priority” by implementing budget plans, accountability documents, performance improvement plans, and data tracking systems. Additionally, the antimicrobial stewardship team must include an infectious disease doctor, and infection preventionist, a pharmacist, and a practitioner, and adhere to the seven core elements of antimicrobial stewardship outlined by the CDC last year.

Almost simultaneously, CMS released a proposed rule updating infection prevention regulations that have been in place for 30 years, along with new Conditions of Participation (CoP) requiring every hospital to have an antibiotic stewardship program.

Although CMS’ infection prevention CoP has been subject to just one minor change since the regulation was implemented in 1986, CMS notes that many of the infection prevention changes proposed in the new rule have been included in the agency’s Interpretive Guidelines since 2008.

For that reason, much of the attention is focused on the new requirements surrounding antibiotic stewardship. Under the proposed regulation, hospitals would be “required to improve their internal coordination among all components responsible for antibiotic use and reducing the development of resistance, including, but not limited to, the infection prevention and control program, the QAPI program, the medical staff, nursing services, and pharmacy service.” But CMS also left considerable leeway in its proposed rule, allowing hospitals to choose their own evidence-based guidelines from organizations like Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the American Society for Health System Pharmacists, and the CDC.

Otherwise, the program must be rolled out to all departments, demonstrate improvement in proper antibiotic use, and maintain sufficient oversight from the hospital’s governing body.

This is an excerpt from Patient Safety Monitor Journal. Subscribers can read the full article here. Find out more about the journal, it’s benefits, and how to subscribe by clicking here.