Tele‐antimicrobial stewardship programs: A review of the literature and the role of the pharmacist

Abstract

Antimicrobial overuse and multidrug‐resistant pathogens are growing problems throughout the United States, yet most counties in the United States lack access to infectious diseases (ID) expertise. Developing an effective antimicrobial stewardship program (ASP) is challenging for many health care institutions, especially rural, community, and critical access hospitals with limited access to specialty care. Pharmacists are instrumental for the success of ASPs and pharmacy expertise is a requirement to meet federal ASP standards. Antimicrobial stewardship guidelines suggest telehealth consultation as an acceptable alternative to in‐person availability of an ID physician‐pharmacist team and encourage facilities to consider creative solutions for optimizing antimicrobial use. As a result, an understanding of successful telemedicine and tele‐ASP (TASP) models as a sustainable option is crucial. Data on existing TASP models, the role of clinical pharmacy services in TASPs, and future directions are herein described. Existing data on TASP are organized into three main categories of fully remote, integrated, or collaborative TASP models. TASPs may be led by remote ID physicians and/or ID‐trained clinical pharmacists within an affiliated health system or from an unaffiliated private practice, health system, or private telehealth entity. The on‐site stewardship pharmacist champion has a vital role in the success of many of the TASP models described by building trusting relationships with prescribers and key stakeholders, facilitating uptake of interventions and acceptance of the TASP, and ensuring timely therapy changes for patients. Future targets for TASP research should include TASP efforts in critical access hospitals and nonacute settings, the specific role of technology and clinical decision support software tools in TASP to improve and enhance pharmacist impact, and further descriptions of TASP models that improve patient‐centered outcomes.

Development of a Centralized Antimicrobial Stewardship Program Across a Diverse Health System and Early Antimicrobial Usage Trends

“…Our findings, combined with results from other groups, suggest that multiple models of AS approaches for smaller hospitals may lead to successful outcomes. Several tele-antimicrobial stewardship models have been reported [ 18 ]. In our model described here, smaller hospitals with limited local resources yet aided by a central stewardship team showed similar rates of decline in antibiotic usage as larger hospitals with robust ID and AS resources onsite.…”

Antimicrobial Prescribing in the Telehealth Setting: Framework for Stewardship During a Period of Rapid Acceleration Within Primary Care

“…Current literature regarding telehealth and AMS pertains to tele-antimicrobial stewardship programs, where infectious diseases and AMS expertise is provided remotely via telehealth consultation to clinical settings without traditional in-person infectious diseases/AMS expertise, especially rural, community, and critical access hospitals [ 22 ]. However, AMS is needed during telehealth appointments when antibiotics are considered.…”

Impact of a pharmacy-driven MRSA nares screening protocol on vancomycin discontinuation in a tele-antimicrobial stewardship model

“…[5][6][7] Tele-antimicrobial stewardship (TASP) is a novel means of bringing ID and ASP expertise to community nonacademic hospital settings. 8 To our knowledge, the role of MRSA nares screening in a TASP model has not been described.…”