Antimicrobial Stewardship Transition of Care

Antimicrobial stewardship (AMS) efforts are mandated by the Centers for Medicare and Medicaid Services and The Joint Commission (TJC). Many AMS efforts have traditionally focused more on the inpatient setting rather than at patient transitions of care or outpatient settings.

Medication management Transition of care (TOC) efforts are known to improve patient care. Pharmacy interventions to improve TOC have focused on preventing harm, reducing readmissions and optimizing care. Pharmacy TOC best practices evaluate metrics such as readmissions, length of stay, emergency department visits, medication-related problems at medication reconciliation, disease-specific metrics and patient satisfaction related metrics.

At Henry Ford Health System (HFHS), the multidisciplinary team implemented an AMS TOC program focusing on optimization of oral antimicrobial therapy for discharge. This work was supported through a contract from the Centers for Disease Control and Prevention (CDC).

References: American Society of Health-system Pharmacists and American Pharmacists Association: ASHP-APhA medication management in care transitions best practices.
The Joint Commission Antimicrobial Stewardship Information

Beginning an AMS TOC program

Barriers to beginning such a TOC program may include financial resources, staffing resources, electronic transfer of information to data, communication and developing partnerships among inpatient and outpatient partners. When designing an AMS TOC model, it is imperative to understand the current process at your institution and address anticipated barriers prior to initiating the program.

A gap analysis may help identify opportunities for improvement and prioritization.

AMS TOC Gap Analysis Tool

AMS TOC Strategies for Community versus Academic Hospitals

Provider and pharmacist practice models may differ between community and academic hospitals. For example, some institutions may have pharmacists present during patient care rounds and other models include a daily phone call to the provider to discuss antimicrobial therapy recommendations. Additionally, some institutions may use electronic health records to identify a potential discharge date where others may not. It is important to consider these model differences and communication strategies when designing a AMS TOC program. Processes can be modified to fit a variety of settings.


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