Common sense can help guide antibiotic use, Joint Commission official says
“If you got on an airplane and you asked the pilot/co-pilot, ‘Is this plane safe and are we going to get to our destination?’ and the pilot/co-pilot said, ‘Probably,' what would you do?” Dr. Ronald Wyatt, medical director of healthcare improvement for The Joint Commission, asked.
That question might not appear to have a healthcare context, but it does. One of Wyatt's responsibilities is to study antibiotics and patient safety, and in advance of a discussion on that topic at ABX Crossroads (ABXC) in Nashville, Wyatt spoke with Healthcare Dive about the importance of antibiotic stewardship and how healthcare executives can help such initiatives.
The inaugural ABXC event, in response to increasing concerns about antibiotic resistance and bacterial superbugs, will convene Nov. 6 to explore the clinical, financial and operational challenges facing healthcare providers in the “post-antibiotic era.”
Wyatt, given his airplane example, stated from an antibiotics viewpoint, if he’s a patient asks a provider, “Why are you giving me an antibiotic?” and the response is because the doctor knows best, “That’s not a good enough reason.”
According to the Centers for Disease Control and Prevention, “Each year in the [U.S.], at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.” A recent email from ABXC says up to 50% of all antibiotics in the U.S. are not needed. “Antibiotic resistance is a global crisis responsible for almost one out of every five emergency department visits for adverse drug events,” according to the statement.
Wyatt said healthcare leaders need to look toward healthcare delivery quality and one way to stymie it is through antibiotic overuse. “Why do we keep giving out antibiotics to people who have viral infections?” he asked.
Overuse issues contribute to antibiotic resistance and set up the discussion for effective antibiotic stewardship, Wyatt said. “We know antibiotic stewardship is a proven method of reducing inappropriate use of antibiotics.”
Antibiotics, Wyatt notes, can cause significant complications such as the loss of vision or hearing and can even lead to death. The duration of hospital stays for patients with antibiotic-resistant infections was prolonged by 6.4 to 12.7 days, collectively adding an extra 8 million hospital days, according to an April article published in Pharmacy and Therapeutics. The extra days take up time and resources and money in an already strained and complicated environment.
In addition, hospital-acquired infections such as C. difficile, which can be caused by the use of a board spectrum antibiotic, can cause reputational and litigation problems for health systems and providers. These harm rates can also be uploaded to patient safety reports like The Leapfrog Group and accreditation bodies like Joint Commission and CMS adding to the myriad problems associated with the potential overuse of antibiotics.
What can healthcare executives do?
In general terms, Wyatt advises measuring antibiotic usage. In addition, matching compliance rates with empiric guidance or working with pharmacies to give them the authority to step in and say when an antibiotic needs to be changed could be part of an antibiotic stewardship program. If using care bundles, Wyatt says to track what are the compliances rates with those bundles. “Those bundles will tell you how to manage antibiotics.”
“Having some kind of antibiotic stewardship structure…has to come top down from the leadership to the culture,” he said.
Programs can be notoriously hard to implement in aforementioned waters of a healthcare environment. So how can a healthcare CEO be convinced in implementing a program and creating a culture of antibiotic stewardship?
“Who’s in control of flying jets with bombs and rockets off the deck of an aircraft carrier?” Wyatt asked. “They’re 19- and 20-year-olds.”
That is the case despite the complexity of takeoffs, landings and maintenance, he noted. “So as a healthcare executive, you’re going to tell me you have 'x' number of lives in your organization every day and you don’t have the ability to protect the patients?"
“Why should the safe use of antibiotics not be a high reliability area to manage?” he asked. In addition, he doesn’t believe healthcare executives would want to risk the loss of their reputation and pay more for complications morbidity and extra hospitalization days as the industry shifts towards value-based purchasing.
Wyatt says an antibiotic stewardship program doesn’t have to be complicated and can rely on common sense -- for example, making sure staff wash their hands, the walls and floors are clean, and if a patient with a virus was in a bed and discharged, making sure the bedding and area are properly cleaned.
“That’s culture and leaders have to be there to hold people accountable and create that kind of culture," Wyatt noted.
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