Posted on August 16, 2015
“If i didn’t do a PGY2 residency in infectious disease; can I still be the antimicrobial stewardship program pharmacist?” If you have not received formal infectious disease training, can you still be qualified to be part of antimicrobial stewardship team?
The Presidential Executive Order 13676: Combatting Antibiotic Resistance Bacteria released in September 2014, the President’s Council of Advisors on Science and Technology (PCAST) report, and the subsequent National Action Plan for Combating Antibiotic-Resistant Bacteria call for a national mandate for acute care settings to establish an antimicrobial stewardship program (ASP) as part of the Conditions of Participation (COP) from Centers for Medicare and Medicaid Service (CMS).
The National Action Plan explicitly states that the ASP should be in compliance with recommendations from the Centers for Disease Control and Prevention’s (CDC) Core Elements of Hospital Antibiotic Stewardship Programs. 7
Since the announcement of this upcoming national mandate, hospitals and healthcare providers are experiencing a sense of urgency to implement an ASP at their facilities in anticipation of the COP requirement. The CDC’s core elements document outlines recommendations on developing an institutional ASP. It states that the core members for antimicrobial stewardship program shall be composed of a single physician leader responsible for the program outcomes and a single pharmacy leader who will co-lead the program by providing drug expertise.2
One of the biggest challenges that smaller hospital pharmacy departments may face is having staff with limited or no formal infectious diseases (ID) training. While literature demonstrates that formal training in ID can benefit stewardship program leaders, formal ID training is not a requirement for ASP core members. For example, a hospitalist can often be ideal physician leader due to their expertise in patient care and commitment to quality improvement. 2
The American Society of Health-System Pharmacists (ASHP) released a statement on the role of pharmacists in ASP in 2010. Pharmacists are expected to:
Collaborate with multidisciplinary team to ensure appropriate antibiotic use to optimize patient outcomes
Develop restricted antimicrobial-use procedures, therapeutic interchange, treatment guidelines and clinical care pathways
Collaborate with Pharmacy and Therapeutics (P&T) committee to maintain an appropriate antibiotic formulary based on the patient population served
Generate and analyze antimicrobial use related metrics
Work with microbiology personnel to ensure appropriate microbial susceptibility tests
Provide education and information on ASP via clinical conferences, newsletters, in-services for healthcare professionals on topics such as antimicrobial use and resistance.1
ASHP recognizes the shortage of formal PGY2 ID residency positions and suggests that pharmacists without formal training may have to acquire antimicrobial stewardship responsibilities.
In contrast, Ernst et al., along with Society of Infectious Disease Pharmacists (SIDP) and American College of Clinical Pharmacists (ACCP) provide recommendation on the training and certification for pharmacists practicing in ID pharmacotherapy. Ernst recommends a future ID-trained pharmacist to attain a PGY1 residency and a PGY2 residency in ID. No recommendations were made to establish training requirements for pharmacists with extensive on-the-job training in ID. 5
Although there is no standardized specialty examination that would certify formally ID trained pharmacists or on-the-job trained ID pharmacists, there are certificate programs for pharmacists looking for ID training. SIDP and Making-a-Difference in Infectious Diseases Pharmacotherapy (MAD-ID) provide such certificate training programs.
The SIDP program is composed of 3 components: an independent internet learning didactic, live webinars that are offered quarterly, and finally, a practical skill component (project-based) at practice site.
MAD-ID offers two programs: a basic program that focuses on the basic skills and overview of ASP, and an advanced program designed for pharmacists and physicians that have some antimicrobial stewardship experience. The basic program is structured similarly to the SIDP program while the advanced program entails a didactic component that requires traveling to MAD-ID’s annual conference and a practical skill component at gained at a practice site.
To become a pharmacy leader as part of ASP, you do not need formal PGY1 and PGY2 residency training in ID. However, you will need to be an agent of change and be passionate about improving antibiotic usage and patient outcomes. Whether you have extensive on-the-job training or you are interested in becoming a change agent to decrease antibiotic resistance, I would strongly recommend you to enroll in the SIDP or MAD-ID certificate programs. You may contact your human resource department to find out if the certificate training program would qualify for tuition or professional training reimbursement at your organization.
For more information on SIDP and/or MAD-ID certificate programs:
ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control. Am J Health-Syst Pharm. 2010;67:575-7.
Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/getsmart/healthcare/ implementation/core-elements.html.
Crader MF. Development of Antimicrobial Competencies and Training for Staff Hospital Pharmacists. Hosp Pharm 2014; 49(1):32-41.
Dellit TH, Owens RC, McGowan Jr. JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of American Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clinical Infectious Diseases 2007; 44:159-77.
Ernst EJ, Klepser ME, Bosso JA, et al. Recommendations for Training and Certification for Pharmacists Practicing, Mentoring, and Education in Infectious Disease Pharmacotherapy: Joint Opinion of the Society of Infectious Diseases Pharmacists and the Infectious Diseases Practice and Research Network of the American College of Clinical Pharmacy. Pharmacotherapy 2009;29(4): 482-8.
Rohde JM, Jacobsen D, Rosenberg DJ. Role of the Hospitalist in Antimicrobial Stewardship: A Review of Work Completed and Description of a Multisite Collaborative. Clinical therapeutics. Jun 5 2013.
Srinivasan A. Engaging hospitalists in antimicrobial stewardship: the CDC perspective. Journal of hospital medicine : an official publication of the Society of Hospital Medicine. Jan 2011;6 Suppl 1:S31–33.
Wong Y, Dill M, Hartman C. America’s Strategy on Combating Antibiotic-Resistant Bacteria. Patient Safety and Quality Healthcare 2015 June 1; May-June 2015: 14 – 19.