PURPOSE:

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The purpose of this procedure is to outline the responsibilities of the Antimicrobial Stewardship Program (ASP) team, which is comprised of ASP Prescribers and ASP Pharmacists

DEFINITION:

1. The ASP Prescriber is an Infectious Disease (ID) Physician.  This person is responsible for directing the program, education, and objectives.  This person is available for direct or indirect discussion to assist other prescribers about antimicrobial selection, education, and recommendations.
2. The ASP Pharmacist is an ID-trained NYS Registered Pharmacist.  This person will perform antimicrobial rounds, consult with prescribers, and perform duties assigned by the ASP prescriber and/or Director of Pharmacy.  This person will assist in providing antimicrobial pharmacotherapy education, selection, and recommendations to the medical staff, including prescribers, nurses, and pharmacists.

STANDARDS OF PRACTICE:

An Antimicrobial Stewardship Program (ASP) monitors and promotes the safe and effective usage of antimicrobials by selecting the appropriate medication, dose, duration, and route of administration in order to improve patient outcomes, while minimizing adverse drug events, emergence of antimicrobial resistance, and reduce expenses.

PROCEDURE

For the ASP Pharmacist

• Review inpatient antimicrobial use for appropriateness based upon indication, dosage, route of administration, and frequency.
• Once cultures and sensitivities are available, the ASP Pharmacist will review for accuracy of antimicrobial selection and opportunities to escalate/de-escalate therapy.
• If the patient does not have a medication level ordered, the ASP Pharmacist will contact the prescriber to have a medication level ordered and adjust the dosage accordingly.
• Antimicrobial doses and frequency will be adjusted by the ASP Pharmacist as needed based upon renal and hepatic function in accordance with the Renal Impairment – Automatic Dosing Conversion policy.
• If an antimicrobial intervention is required, the ASP Pharmacist will contact the prescriber managing the patient. If however the recommendation is declined, the ASP Pharmacist will then contact the ASP Prescriber for further review and actions.
• All clinical interventions relating to Antimicrobial Stewardship will be documented in the Soarian Pharmacy program and reported to the MMQAPI and P & T Committees.
• The ASP Pharmacist will review all medication orders for restricted antimicrobials for appropriateness and compliance with existing policy Medication Orders-Restricted Antimicrobials.
• The ASP Pharmacist will conduct at least one MUE annually.
• All switches from IV to PO therapy will be conducted in accordance with existing policy.

·                    Develop empiric treatment guidelines to minimize the development of resistant organisms

·                    Develop antimicrobial dosing guidelines to improve patient outcomes

·                    Review all serious adverse events associated with antimicrobials and vaccines.

·                    Create procedures to prevent adverse events associated with antimicrobials and vaccines from occurring.

For the ASP Prescriber

• Develop criteria for use for all restricted antimicrobials
• Develop MUE criteria with the ASP Pharmacist
• Create empiric therapy guidelines based upon antimicrobial susceptibility rates to be part of the antibiogram
• Develop empiric treatment guidelines and protocols to minimize the development of resisitant organisms.
• Meet with prescribers who refuse to comply with Antimicrobial Stewardship procedures and guidelines and provide them with one-on-one education. If this is not effective, the ASP prescriber will notify the Chief Medical Officer (CMO) for resolution of issues.
• Report progress of the Antimicrobial Stewardship Program to the Medical Executive Committee

   For the ASP Prescriber and ASP Pharmacist

• The ASP Prescriber and ASP Pharmacist will perform periodic review of antimicrobial susceptibility rates:
  • The ASP Prescriber, ASP Pharmacist, microbiologist, and Infection control and prevention manager will work collaboratively to publish the annual antibiogram
  • The ASP Prescriber and Pharmacist will create empiric therapy guidelines based upon antimicrobial susceptibility rates to be part of the antibiogram.
  • The ASP Pharmacist will provide lists of formulary parenteral and oral antimicrobials with recommended doses and expenses to be incorporated into the antibiogram
  • The ASP Prescriber and ASP Pharmacist will assist the Infection Control and Prevention manager in tracking the number of MRSA, VRE, ESBL, and CRE cases reported and aid in the reporting of data to the Infection Control Committee.