The era of mandatory antimicrobial stewardship for hospitals and nursing homes is now upon us. The Joint Commission’s, “New Antimicrobial Stewardship Standard: Applicable to Hospitals and Critical Access Hospitals,” and, “New Antimicrobial Stewardship Standard: Applicable to Nursing Care Centers,”1 went into effect as of January 1, 2017. Although many facilities are playing catch-up and are rapidly working to implement their Antimicrobial Stewardship Programs (ASPs), the benefits of these programs are beyond question and these mandates are well overdue.
According to the CDC, 20%–50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate, and the problem is even worse in nursing homes.
Antibiotics are among the most frequently prescribed medications in nursing homes: 70% of residents of long-term care facilities receive at least one course of systemic antibiotics each year, and between 40%-75% of these drugs are unnecessary or inappropriate.2 In May of 2017, researchers at Columbia University published a report showing that between 11% and 59% of residents at U.S. nursing-homes are colonized by multidrug-resistant gram-negative bacteria.3
While going through the process of selecting an electronic health record (EHR) platforms, many hospitals assume that these systems include ASP functionality or can easily integrate with ASP software, but that isn’t true. ASP platforms for large EHR systems are not plug-and-play, and many of the ASP tools available were designed in-house by a hospitals’ IT staff. These may not necessarily suit your hospital’s needs. EHRs do not typically offer advanced functions, including Drug-Bug mismatch decision support, institutional antibiogram, or calculations for improved days-of-therapy.
Partners Healthcare in Boston analyzed the electronic prescribing Clinical Decision Support (CDS) aspect of its EHR and found that the systems dramatically increased over-alerting and alarm fatigue. As a result, physicians began to override the alarms.
Partners Healthcare analyzed 157,000 CDS alerts and two million medication orders. They concluded that over half of the alerts were overridden. Of those, 53% were clinically appropriate alerts that should not have been ignored.4
So, for facilities still in the process of building and implementing an ASP, don’t assume that integration with your EHR will be easy. In an article on the topic published in the journal Clinical Infectious Diseases, the authors provide this valuable advice:
“Although EHR systems are being implemented rapidly throughout the United States, they are primarily focused on clinical functionality and patient care, leaving decision-support functionality to be implemented by individual facilities. The scope of CDS tools included in EHRs are typically limited to medication safety or to generating lists of patients who have specific characteristics or are receiving specific medications.”5
Opinions expressed in this article are not necessarily those of bioMérieux, Inc.
About the Author:
Dr. Kevin RiversFounder, KCR AND ASSOCIATES
Dr. Kevin Rivers is the founder of KCR AND ASSOCIATES, a team of consultants who have held leadership positions in acute care hospitals, pharmacies, ambulatory infusion therapy services, medical device, in-vitro diagnostics, healthcare software and life sciences industries.
References:
- Joint Commission Perspectives®, July 2016, Volume 36, Issue 7
- The Core Elements of Antibiotic Stewardship for Nursing Homes, Centers for Disease Control and Prevention; https://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html
- Sainfer A. et al, Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents: A systematic review and meta-analysis; American J. of Infection Control; May 1, 2017, Vol 45, Issue 5, p 512–518.
- Darves, Bonnie. Overrides of Clinical Decision Support Alerts Persist, Groups Try to Address Issue. iHealthBeat. November 11, 2013.
- Forrest G , Use of Electronic Health Records and Clinical Decision Support Systems for Antimicrobial Stewardship, Clin Infect Dis. 2014 Oct 15;59 Suppl 3:S122-33. doi: 10.1093/cid/ciu565.
