The Journal of the Arkansas Medical Society Med Journal March 2020 Final 2 | Page 12

EDITORIAL PANEL: Chad T. Rodgers, MD, FAAP | Elena M. Davis, MD, MPH | Shannon Edwards, MD | William L. Mason, MD | J. Gary Wheeler, MD, MPS Update on Antimicrobial Stewardship Efforts in Arkansas MARSHA F. CRADER, PharmD S even years after the first guide- line recognizing antimicrobial stewardship (AS) was intro- duced in 2007, the Centers for Disease Control and Prevention (CDC) released the first AS core elements, outlining the personnel and practices needed for successful antimicrobial stewardship programs (ASPs). 1 CDC’s core elements were followed by the Joint Commission and Centers for Medicare & Medicaid Services (CMS) AS requirements within hospitals, hospital clinics and nursing homes. In January 2020, the Joint Commission began requiring hospital outpatient departments to implement steward- ship practices: determine an annual goal, provide education to improve usage, and track and report. Pharmacists’ vital role in these regulatory requirements is evidenced by pharmacist leadership in hospital ASPs, especially those without infec- tious-diseases physicians. According to 2018 National Healthcare Safety Network (NHSN) hospital survey data, 85% of hospitals’ ASPs have pharma- cist leadership, specifically, 59% are co-led by pharmacists and physicians; 26% have pharmacist-only-led stew- ardship programs. 2 CDC specifically recognized the efforts and critical role 204 • The Journal of the Arkansas Medical Society of pharmacists when it replaced the “Drug Expertise” section with “Phar- macy Expertise” in the 2019 update. 2 ROLE OF PHARMACISTS IS CHANGING Pharmacists throughout the United States are improving their knowledge in order to be an essential part of AS teams. There are limited residency positions for pharmacists to receive post-graduate training in infectious diseases. Pharmacists have been obtaining AS training certifi- cates to demonstrate advanced train- ing. The Society of Infectious Diseases Pharmacists and Making a Difference in Infectious Diseases are the certif- icate programs currently available. Most require a quality improvement project after completion of continu- ing education programs. During Arkansas’ 2018–19 AS state collabo- rative, 60 certificate program scholar- ships were awarded to pharmacists practicing in hospitals and nursing homes. CDC also has an antibiotic training series for health care pro- fessionals, including more than 10 hours of free continuing education hours. CDC’s training modules meet certain requirements for the CMS Merit-Based Incentive Programs and can be useful to physicians wanting to learn more about AS. Multiple opportunities for educa- tion have been made available. The Arkansas Department of Health has been a partner with both AS state collaboratives. The first collaborative was led by the Arkansas Hospital Association and the Arkansas Associ- ation of Health-System Pharmacists. During the 2015–16 AS collaborative, pharmacists were trained in the basics of hospital AS and shared ideas to meet the CDC’s core elements for AS. The 2018–19 state AS collaborative was led by the Arkansas Foundation for Medical Care (AFMC). Education was expanded to include additional health care disciplines from hospitals and nursing homes. Participants were provided with basic and advanced AS and infection prevention education as well as opportunities to share stew- ardship intervention successes. COLLABORATION BOOSTS IMPROVEMENTS AS collaboration is key to Arkan- sas’ successful work in this vital area. Providing general AS education to different disciplines is important but understanding each discipline’s unique role and thought processes can lead to