3 challenges ASC face in multidisciplinary antibiotic stewardship program implementation

Antibiotic stewardship is a key component of infection prevention, and may be quite challenging as antibiotic stewardship varies across the continuum of care, says Phenelle Segal, RN CIC, owner of Infection Control Consulting Services. Ms. Segal explains a successful antibiotic stewardship entails utilizing a multidisciplinary approach, where different medical professionals work hand-in-hand to ensure facilities are compliant every step of the way. While hospitals have been working for several years to develop these programs, the concept is relatively new for ASCs and they face a certain set of challenges when devising a program.

Here are three challenges ASCs face in implementing a multidisciplinary antibiotic stewardship program:
phenelle 11. Inappropriate antibiotic use. Throughout her experience working with ASCs, Ms. Segal has seen providers administer additional dose of antibiotics to potentially minimize the patient's risk of developing a surgical site infection when not indicated. A patient may require an extra antibiotic dose if their body mass index exceeds a certain range, if their procedure surpasses a certain hour range or for other appropriate medical reasons. Several surgery specialties have developed guidelines for procedures and they often include strategies for antibiotic prescribing.
The primary role of antibiotic stewardship for ASCs includes the government's role in clamping down on misuse of antibiotics because of the rise of often deadly multidrug resistant organisms.
In ASCs, patients typically leave within 23 hours, which may draw concerns about monitoring postoperative antibiotic compliance. Surgeons may prescribe a post-operative course of antibiotics when the patient leaves, even if the course is not indicated based on the procedure or guidelines, Ms. Segal explains.
2. ASCs often lack the resources to integrate a multidisciplinary approach. Hospitals generally have more resources than their ASC counterparts to get a program off the ground. A multidisciplinary approach in the stewardship program entails coordination between hospital staff, lab personnel, infection preventionists and many others dedicated to ensuring the program runs well.
"It is hard to develop a program in ASCs because most facilities don't have easy access to laboratory results, pharmacy personnel and other resources such as those available in hospitals," she says. "The center's infection preventionist due to his/her wearing 'many hats' and training in the operating room environment versus in infection prevention is not well-versed in antibiotic stewardship. However, federal regulations are geared towards this being a coordinated effort and it should be the responsibility of all institutions across the continuum of care."
3. ASCs face an education & guidelines deficit. ASCs may find it particularly challenging to develop a program due to a lack of education and standardization of process measures.
"There is also a significant knowledge deficit in this area amongst healthcare providers, as it has not been in the forefront of healthcare until more recently" says Ms. Segal.  
"We need guidelines and standards for outpatient surgery prescribing so everyone can be on the same page," she adds. "Going forward, the responsibility will be on the infection preventionists to be in charge of the AMS program together with other facility key players including medical providers.  That is where we are with the hospitals right now. [Right now] ASCs will likely have to develop a team of key players to develop an antibiotic stewardship program that is perhaps on a smaller scale than hospitals who have already instituted multidisciplinary teams."
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