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
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