An estimated 2 million people become infected with bacteria that are resistant to antibiotics each year in the United States. The concept of antimicrobial stewardship (AS) efforts to improve antibiotic prescribing through structured, multidisciplinary programs has led the vast majority of health care organizations to establish formal leadership commitment and organizational structures to support AS. However, a need exists to strengthen AS programs by going beyond current guidelines and established practices. 

A new article in the upcoming July 2019 issue of the 

Joint Commission Journal on Quality and Patient Safety

 (JQPS) details findings from a 2018 meeting sponsored by The Pew Charitable Trusts and The Joint Commission. The article, "Leading Practices in Antimicrobial Stewardship: Conference Summary," by David W. Baker, MD, MPH, FACP, and co-authors, details two interventions identified by panelists during the meeting as leading practices that go beyond current AS guidelines and established practices:

- Diagnostic stewardship: Addresses errors in diagnostic decision-making that lead to inappropriate antibiotic prescribing.
- Handshake stewardship: Method of engaging frontline providers on a regular basis for education and discussion about barriers to antimicrobial stewardship from a clinicianÃ¢â¬â¢s perspective.

The panel also identified days of therapy (or defined daily dose, when days of therapy are not possible), Clostridioides difficile rates and adherence to facility-specific guidelines as the preferred measures for assessing AS activities.

"Stewardship programs can reduce inappropriate antibiotic use in hospitals and help slow the emergence of antibiotic resistance," said David Hyun, MD, senior officer with The Pew Charitable Trusts. "The practices highlighted by the experts in the Joint Commission Journal on Quality and Patient Safety article will help enhance the quality of stewardship programs in all hospitals."

The Centers for Disease Control and Prevention plans to update its Core Elements of Hospital Antibiotic Stewardship Programs, and the Joint Commission will place greater emphasis on efforts to improve AS based on takeaways from the meeting.

The article is "Leading Practices in Antimicrobial Stewardship: Conference Summary," by David W. Baker, MD, MPH, FACP; David Hyun, MD; Melinda M. Neuhauser, PharmD, MPH, FCCP, FASHP; Jay Bhatt, DO, MPH, MA, FACP; and Arjun Srinivasan, MD. The article is to appear in The Joint Commission Journal on Quality and Patient Safety, volume 45, number 7 (July 2019), published by Elsevier.