She added, “We have to figure out how to balance the reality of these sources in long-term care with what is really needed to change prescribing practices, I think we need to be more innovative and I actually think we need to be more accepting of our role in long-term care as physicians because I think everyone rolls their eyes except for the brave few who actually do this. This is a public health issue. We need to involve ourselves in long-term care.”
When it comes to the future of antibiotic stewardship, the number of hospitals and long-term care facilities with ASPs is going to “dramatically increase” in the United States, according to Dr. Cosgrove. Although the requirements will not solve all of the problems that need to be addressed, staying on top of how these requirements are developed and applied is imperative.
In order to improve ASPs, a clear understanding of the “best practice in stewardship interventions in different settings” is needed. According to Dr. Cosgrove, it is also imperative to “expand the evidence base for optimal antibiotic use,” to “improve measurement of overall and appropriate antibiotic use” and to improve integration of efforts across all healthcare settings. She explained, “We tend to silo ourselves. We need to open that conversation a little bit more because we really need to improve this across the board, not just in an individual hospital or an individual setting.” Gaining better insight into prescribing behavior is also needed.
Dr. Cosgrove shared a little bit about the Agency for Healthcare Research and Quality, Safety Program for Improving Antibiotic Use, which is based off of a previous program called the Comprehensive Unit Based Safety Program, or CUSP. This program worked to reduce central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated events (VAE) through intervention. She explained, “The idea is that you make healthcare safer by improving the foundation of how physicians, pharmacists, nurses, and all other healthcare team members work together by combining the best clinical practices with the science of safety.” Dr. Cosgrove wants individuals to reflect on “the best way to prescribe antibiotics” in acute care, long-term care, and ambulatory care. She joked, “If we are alive to tell the results in four years, I’m hopeful that I will tell you that an adaptive approach to stewardship is a good thing.”
She concluded, “I think that there’re two pieces of the pie. First, we have to leverage and improve new requirements to develop and expand stewardship across the healthcare spectrum. Then, we have to work to modify behavior around antibiotic prescribing by addressing these adaptive concerns. And if we do that, I think we will see sustained improvement in antibiotic use, and then antibiotics will be great again!”
Consulting: Novartis—infection adjudication committee; Theravance—infection adjudication committee
2017 SHEA Spring Conference
Opening Plenary: A Rapidly Changing Field
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