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Implementing Antimicrobial Stewardship Efforts Across Different Healthcare Settings

 The CDC recommends implementation of antimicrobial stewardship efforts across various healthcare settings (acute, post-acute and long-term, and ambulatory care) as a way to improve antimicrobial prescribing and ultimately to improve patient safety and care.  Although various antimicrobial stewardship guidance documents serve as outlines for implementation, they are not detailed plans on how to bring AS efforts or programs into full fruition.

At the Nebraska Antimicrobial Stewardship Summit, Drs. Van Schooneveld, Ashraf, Marcelin, and Green-Hine presented practical strategies on implementation of AS efforts in different healthcare settings.  You can watch these presentations in the Nebraska ASAP YouTube channel.

Dr. Van Schooneveld spoke about antimicrobial stewardship interventions in the acute care setting.  He highlighted a strategy to identify what AS interventions should be implemented based on facility prescribing practices and needs.  Antimicrobial stewardship interventions implemented at Nebraska Medicine was used as examples of what can be implemented in hospitals of varying sizes.  In one specific example, Dr. Van Schooneveld outlined relevant clinical and microbiological data that should be reviewed during an antimicrobial time-out process.

Implementation strategies in post-acute and long-term care were presented by Dr. Ashraf.  Based on his experience working with long-term care facilities and consultant pharmacists, Dr. Ashraf described how facilities can become compliant with the CDC Antimicrobial Stewardship Core Elements and CMS requirements.  Important facets such as implementing antibiotic use protocols, tracking and reporting of process and outcome measures, and education of facility prescribers and staff were discussed.

Drs. Marcelin and Green-Hine co-presented the outpatient antimicrobial stewardship session in which they described the process of C-D-I-F-F.  “Not that C diff” said Dr. Marcelin during the presentation.  The C-D-I-F-F Dr. Marcelin was referring to is the stepwise strategy of Collaboration, Data, Intervention, Feedback, and Follow-up for outpatient antimicrobial stewardship implementation.  As an example of the Intervention step, Dr. Green-Hine provided a specific example on how to communicate with a patient during a clinic session in order to manage patient expectation to be prescribed antibiotics.

To learn more about these practical strategies of implementation, visit the Nebraska Antimicrobial Stewardship Summit Presentation page or our YouTube channel.

Written by Phil Chung, PharmD, MS, BCPS

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