Hospital Pharmacy - September 2017 - 527

721541
research-article2017

HPXXXX10.1177/0018578717721541Hospital PharmacyDavis et al

Letter to the Editor

Navigating the New Antimicrobial
Stewardship Regulations

Hospital Pharmacy
2017, Vol. 52(8) 527-531
© The Author(s) 2017
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https://doi.org/10.1177/0018578717721541
DOI: 10.1177/0018578717721541
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Sondra Davis1, Collin Verheyden2, Mandelin Cooper3,
and Devak Desai4

Abstract
Purpose: Many health care facilities are navigating their way through the new antimicrobial stewardship standards and
guidelines. The purpose of this article is to provide information for health care facilities to improve patient care. Summary:
New regulations and guidelines surrounding antimicrobial stewardship have prompted facilities to review their process
related to antimicrobial stewardship. In setting up a program, there are many factors to consider including involving key
personnel, obtaining leadership support, identifying an infectious disease physician to chair or cochair the committee, and
meeting agenda, metrics, and educational needs. Conclusion: Antimicrobial stewardship plays a vital role in both our
hospital and community setting. Pharmacists are uniquely positioned to improve optimal patient care through rounding,
review of patients' chart, and contribute to the improvement of antimicrobial stewardship by working with a multidisciplinary
team. These efforts may improve the utilization of antimicrobial agents.
Keywords
antimicrobial stewardship, antimicrobial development, antimicrobial management, antimicrobial stewardship program, antiinfective medications, antibiotics, implementation, antimicrobial regulations
With the recent publication of The Joint Commission standards and other guidelines related to antimicrobial stewardship (AMS), heath care entities now have a renewed focus on
their own programs, regulations, and policies. Facilities with
existing programs are reevaluating their individual goals and
policies with an eye on the new regulations and future direction of stewardship as well as cost savings and clinical outcomes. Many smaller facilities may not have a stewardship
program in place and will need guidance and resources to
start their own programs.

What Is the Importance of AMS?
In Alexander Fleming's acceptance of the Nobel Prize in
1945, he cautioned that exposing patients to subtherapeutic
doses of penicillin would be an ideal situation to breed resistance.1 He warned of the development of resistant strains and
poor patient outcomes as a result.1 This was likely the first
reference to what we refer to as AMS.
Today, much progress has been made in regard to stewardship. Guidelines provide a framework for discussion and action
with the goal to decrease unintended consequences of antimicrobials and optimize clinical outcomes.2,3 AMS programs
have been shown to reduce emerging bacterial resistance
to antimicrobials and improve patient care by de-escalating
to the most appropriate antimicrobial agent(s).4-6 One of
many examples of decreasing unintended consequences is after

implementation of an AMS program in a rural hospital, the
nosocomial Clostridium difficile rate decreased to an average
of 1.6 cases per 10 000 patient-days from an average of 5.5
cases per 10 000 patient-days.7
Pharmacists are on the front lines and play an important role in stewardship by collaborating with the providers to provide the patient with optimal therapy. Pharmacists
may intervene during rounds to de-escalate therapy or recommend discontinuing the antibiotic based upon course
completion. Participation in rounds is another way pharmacists may be an integral part of the patient care. No
matter how big or small rounds are, opportunity for pharmacists exists not only with AMS but also with building
relationships with providers. By improving the relationship between pharmacy and providers, a comradery will
form. Through the relationship, providers may then lean
on pharmacy and be more open to discussions related to
antimicrobial therapy.
1

Medical City Arlington, TX, USA
Parallon Supply Chain Services, Coppell, TX, USA
3
HCA Clinical Services Group Nashville, TN, USA
4
ID Partners, Mansfield, TX, USA
2

Corresponding Author:
Sondra Davis, Medical City Arlington, 3301 Matlock Road, Arlington,
TX 76015, USA.
Email: sondra.davis@hcahealthcare.com
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