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Clinical Corner: Antimicrobial Stewardship – What’s Your Role?

Collaboration has long served as a cornerstone of antimicrobial stewardship program (ASP) efforts to thwart the spread of multi-drug resistant organisms (MDROs) and promote responsible use of antimicrobial agents1. Traditionally, hospital epidemiologists, infectious disease (ID) physicians, ID pharmacists, infection prevention, and microbiology are viewed as common stakeholders in these efforts. More recently, the boundaries are being stretched to examine other healthcare roles, which may have a profound impact on your stewardship program.

Rohde and colleagues (2013) found through an extensive literature review that hospitalists are routinely involved and sometimes even lead ASP efforts2. They go on to emphasize the natural overlap between the daily workflow of hospitalists and core elements of antimicrobial stewardship. Olans et. al. (2016) explored the role of staff nurses in antimicrobial stewardship efforts. Although not well recognized in guidelines for implementing or operating ASPs, Olans et. al. assert that staff nurses are already involved in critical functions, such as antibiotic first responders, patient monitors, and central communicators3. In fact, mentions of this group within program recommendations were limited to 3 to 4 sentences at most! There will continue to be increased emphasis on role characterization in ASPs in the near future as programs evolve and public reporting of related data is widely introduced.

How would you define your role in antimicrobial stewardship? How do you think others perceive your role?

Antimicrobial stewardship has taken the national stage in recent years through executive orders, a national action plan/strategy, and reporting of antimicrobial use and resistance data to the National Healthcare Safety Network. As such, it’s becoming even more critical to ensure your ASP is running on all cylinders while minimizing role ambiguity. Clinical surveillance and clinical decision support tools combined with EMR data, antibiograms, and reporting are being leveraged by stewardship programs to effectively communicate, implement, and monitor key ASP initiatives.

Do you have tools in place to promote collaborative ASP efforts? Are roles and responsibilities as clear as they should be?

 

References:

  1. Moody J, Cosgrove SE, Olmsted R, et al. Antimicrobial stewardship: a collaborative partnership between infection preventionists and healthcare epidemiologists. Am J Infect Control 2012; 40:94–5
  2. Rohde, J. M., Jacobsen, D., & Rosenberg, D. J. (2013). Role of the hospitalist in antimicrobial stewardship: A review of work completed and description of a multisite collaborative. Clinical Therapeutics, 35(6), 751–757. doi:10.1016/j.clinthera.2013.05.005
  3. Olans, R. N., Olans, R. D., & Demaria, A. (2016). The Critical Role of the Staff Nurse in Antimicrobial Stewardship – Unrecognized, but Already There. Clinical Infectious Diseases, 62(1), 84–89. doi:10.1093/cid/civ697

 

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