How to become an antimicrobial stewardship pharmacist

"If I didn't do a PGY2 residency in infectious disease; can I still be the antimicrobial stewardship program pharmacist?" This is a question asked by many smaller hospital pharmacy departments with limited staff, or team members who lack formal infectious disease training. The Presidential Executive Order 13676: Combatting Antibiotic Resistance Bacteria released in September 2014, the President’s Council of Advisors on Science and Technology (PCAST) report, and the subsequent National Action Plan for Combating Antibiotic-Resistant Bacteria called for a national mandate for acute care settings to establish an antimicrobial stewardship program (ASP) as part of the Conditions of Participation (COP) from Centers for Medicare and Medicaid Service (CMS).The National Action Plan explicitly states that the ASP should be in compliance with recommendations from the Centers for Disease Control and Prevention’s (CDC) Core Elements of Hospital Antibiotic Stewardship Programs.1 Furthermore, antimicrobial stewardship program is now a part of the Joint Commission Medication Management standard.²

Since the announcement of this national mandate, hospitals and healthcare providers are experiencing a sense of urgency to implement an ASP at their facilities in anticipation of the COP requirement. The CDC’s core elements document outlines recommendations on developing an institutional ASP. It states that the core members for antimicrobial stewardship program should appoint physicians and pharmacists as co-leaders responsible for the program management and outcomes. Pharmacy expertise is a key core element to ensure successful implementation efforts to improve antimicrobial use.¹

One of the biggest challenges that smaller hospitals may face is having clinicians with formal infectious diseases (ID) training. While literature demonstrates that formal training in ID can benefit stewardship program leaders, formal ID training is not a requirement for ASP core members. For example, a hospitalist can often be ideal physician leader due to their expertise in patient care and commitment to quality improvement. ³

The American Society of Health-System Pharmacists (ASHP) released a statement on the role of pharmacists in ASP in 2010.⁴ Pharmacists are expected to:

• Collaborate with multidisciplinary team to ensure appropriate antibiotic use to optimize patient outcomes
• Develop restricted antimicrobial-use procedures, therapeutic interchange, treatment guidelines and clinical care pathways
• Collaborate with Pharmacy and Therapeutics (P&T) committee to maintain an appropriate antibiotic formulary based on the patient population served
• Generate and analyze antimicrobial use related metrics
• Work with microbiology personnel to ensure appropriate microbial susceptibility tests
• Provide education and information on ASP via clinical conferences, newsletters, in-services for healthcare professionals on topics such as antimicrobial use and resistance.⁵

ASHP recognizes the shortage of formal PGY2 ID residency positions and suggests that pharmacists without formal training may have to acquire antimicrobial stewardship responsibilities. In contrast, Ernst et al., along with Society of Infectious Disease Pharmacists (SIDP) and American College of Clinical Pharmacists (ACCP) provide recommendation on the training and certification for pharmacists practicing in ID pharmacotherapy. Ernst recommends a future ID-trained pharmacist to attain a PGY1 residency and a PGY2 residency in ID. No recommendations were made to establish training requirements for pharmacists with extensive on-the-job training in ID. ⁶