While antibiotic stewardship (ABS) programs are now common in U.S. hospitals (the Joint Commission has required them since 2017), far too many ABS committees lack adequate laboratory representation. Here, three lab leaders—Nam Tran, PhD, MS, MAS, HCLD (ABB), FACB, associate professor of clinical pathology and director of clinical chemistry at UC Davis; Edward Septimus, MD, FIDSA, FACP, FSHEA, clinical professor at Texas A&M College of Medicine; and Michael Broyles, BSPharm, RPh, PharmD, director of pharmacy and laboratory services at Five Rivers Medical Center in Arkansas—discuss why (and which) laboratorians should be part of an ABS team that includes qualified healthcare professionals from across your organization.
The Joint Commission requires hospitals to include at least four individuals—when they are available—on their ABS team: an infectious disease physician, an infection preventionist, a pharmacist, and a medical practitioner. Laboratory representation is not mandated, so many organizations don't include laboratorians on their committees. “Which is amazing to me," says Dr. Broyles. “You would think that they would be very first in."
Decisions that are made regarding the use of antibiotics almost always rely on information that comes from the lab, Dr. Broyles notes. His recommendation: The team should include a microbiologist who can handle “traditional" ABS concerns, and it should feature a biomarker expert who can provide laboratory input on focus-guided therapy.
Another key player on the optimal ABS team is the clinical pathologist, says Dr. Septimus. And, he adds, “you want somebody from the C-suite as well"—a leader from the organization who can advocate for the lab and ensure that it has the resources it needs to be successful.
Laboratory professionals who might otherwise be qualified to join an ABS committee may or may not have the “personality profile" necessary to be an influential participant in the group, says Dr. Tran. “[You] need someone who's outgoing, willing to work and roll with the punches," but at the same time they should be ready “to hold firm, to say, 'This is where we're at.'" In addition, he notes, any laboratory representative should be the type of person “who's willing to show up" at important meetings and ready “to find solutions" to tough challenges, and they should be a well-respected leader. “They should have a say in the decision-making in [his or her] department."
Strong leadership skills are important, Dr. Broyles agrees, as is the ability to remain focused and persistent. “A lot of times, when you're doing something new, you get beat down," he notes. “You know you're doing the right thing, you know that this is what's best for the patients, and sometimes it's just frustrating. You just have to keep staying after it."
Finally, recommends Dr. Septimus, be sure that all laboratory ABS committee participants are excellent communicators. “They need to be very good listeners," he says, and should “respect all points of view," whether they agree with them or not. The whole point of an ABS committee, he notes, is to come to an agreement on what's best for patient care. If you put the right leaders on your ABS team—people who are passionate, but also pragmatic—you'll find that consensus is a lot easier to achieve.
Core Elements of Hospital Antibiotic Stewardship Programs
By Centers for Disease Control and Prevention
86 companies that provide revenue cycle services
By Association for Professionals in Infection Control and Epidemiology