Evidence continues to show that inappropriate and indiscriminant use of antibiotics and other antimicrobial agents has led to the growing problem of antimicrobial resistance, drug-related adverse effects, and higher medical costs.
For more than 80 years, the medical community has relied upon the liberal use of antibiotics to treat infectious diseases. Over time, those infectious organisms have adapted, making certain antibiotics less effective, due to the long-term, widespread use of antimicrobial agents.
Patients who have antimicrobial-resistant infections tend to have longer, more expensive hospital stays, and face a higher risk of death that patients with other types of infections. In fact, it is estimated that antibiotic-resistant organisms kill an estimated 44,000 people, annually, in North America.
The Need for Antimicrobial Stewardship in Health Care Facilities
Antimicrobial stewardship programs were instituted as a systematic way to provide a reduction of antibiotic resistance by:
- Addressing the overuse of antimicrobial agents
- Monitoring the situation
- Measuring the amount of incidents
- Promoting strategies to ensure appropriate antibiotic use
These highly regarded professional health organizations publicly support antimicrobial stewardships programs:
- Society for Healthcare Epidemiology of America
- Infectious Diseases Society of America
- Pediatric Infectious Diseases Society
- In 2007, the California legislature passed a law requiring hospitals to put these programs into place in order to promote appropriate antibiotic prescribing.
Does Your Health Care Facility Have an Infectious Disease Doctor?
In order to properly implement an antimicrobial stewardship program, it is best to have an infectious disease doctor onsite. As more facilities agree this program is essential, many hospitals and long-term care facilities, especially those in rural areas, do not have an infectious disease doctor on staff, and find it difficult or consider it too costly to implement the antimicrobial stewardship program, on their own.
Telemedicine Allows Facilities to Offer the Antimicrobial Stewardship Program
Few health care facilities realize that telemedicine can allow facilities – where there is no infectious disease doctor on site – to offer this stewardship program. This is how telemedicine can effectively administer your facility’s antimicrobial stewardship program:
- The facility’s Antimicrobial Stewardship Program Committee (often consisting of the pharmacy director, two pharmacists, a microbiologist, an infection control coordinator, and a hospitalist) meets with an offsite infectious disease specialist on a monthly basis, via telemedicine. They review the hospital’s antibiogram. This evaluates all bacterial cultures obtained from patients, and measures how susceptible different types of bacteria are to antibiotics. The results will indicate how effective the antibiotics will be against infection. Based on this analysis, the team will designate specific classes of drugs to be targeted, as well as any physician who may be in need of support and education regarding the program.
- Each day, a pharmacist reviews all antimicrobial orders and sets aside those orders for drugs listed as targeted by the committee. Via telemedicine, the pharmacist consults with the offsite infectious disease specialist regarding the appropriateness of the orders. The specialist will sometimes call the prescribing physician to urge them to consider using a drug with a narrower spectrum. The specialist will discuss their recommendations with the prescribing physician, again, via telemedicine.
- On a weekly basis, hospital or community-based physicians can attend multidisciplinary rounds with the infectious disease specialist, via telemedicine, to discuss general issues related to antibiotic use. The specialist provides advice to those who request it on how to manage individual patients suspected of having bacterial infections.
- The offsite infectious disease physician can periodically participate in department-wide meetings (ER, Surgery, Medicine, etc.), making presentations and answering questions about infectious disease issues, including antimicrobial resistance and appropriate use of antibiotics. Over time, once the program is up and running, the committee and the specialist may decide it is necessary to attend these department meetings less frequently.
Antimicrobial Stewardship Programs Are Reducing Antibiotic Use
With the help of telemedicine, facilities who felt they were too small, too rural, or without the staff or funding to implement this necessary program can now do so. Hospitals that have implemented the program are finding more cultures are being analyzed, and they have experienced a reduction in the use of targeted broad-spectrum antibiotics. This has led to fewer cases of bacterial resistance to the drugs.
TeleMed2U developed the first ever telemedicine-based Antimicrobial Stewardship Program to help hospitals meet the clinical and statutory needs of a hospital. It is fully compliant and based on the guidelines set forth by the Infectious Diseases Society of America for Components of Antimicrobial Stewardship Programs. It includes:
- Prospective audit with intervention and feedback
- Formulary restriction preauthorization requirements for specific agents
- Provision of education
- Development of guidelines and clinical pathways
- Identification of combination therapy for prevention of resistance vs. redundant antimicrobial coverage
- Identification of a process for streamlining and de-escalation of therapy
- Dose optimization
For more information about how TeleMed2U can help your facility and staff become fully compliant with California State Law, Senate Bill 739 and assist with the implementation of an antimicrobial stewardship program via telemedicine in any part of the country, please call us at 855-446-TM2U (8628).
