New CMS rule requires ASPs at all hospitals

Antibiotic stewardship programs (ASPs) must be implemented at all acute-care hospitals that participate in Medicare and Medicaid by March 30, 2020, according to a new CMS rule released late last year. This requirement will ensure that small and critical-access hospitals also adopt ASPs in an effort to promote appropriate antibiotic use. 

The CMS rule requires hospitals to implement a robust ASP that follows nationally recognized guidelines for appropriate antibiotic use. The program must be hospital-wide for the surveillance, prevention, and control of hospital-acquired infections and for other infectious diseases. CMS encourages multisystem hospitals to have an integrated ASP with a single governing body that ensures compliance throughout the system.

CMS has guidance specific to critical-access hospital ASPs:

  • Demonstrate coordination among all components of the critical access hospital responsible for antibiotic use and resistance, including but not limited to the infection prevention and control program, the quality assurance and performance improvement program, the medical staff, and nursing and pharmacy services.
  • Document the evidence-based use of antibiotics in all departments and services of the critical-access hospital.
  • Provide proof of improvements, including sustained improvements, in proper antibiotic use, such as reductions in Clostridium difficile infections and antibiotic resistance in all hospital departments and services.

Amy Hanson, PharmD, BCPS AQ-ID, an antimicrobial stewardship and infectious disease pharmacist at the Chicago Department of Public Health, discussed the importance of getting leadership buy-in to ensure the appropriate allocation of resources necessary to support an ASP. Strategies may include designating an individual who reports to the C-suite to be accountable for the outcomes of the ASP and integrating stewardship activities into ongoing quality improvements and/or patient safety efforts.

Hanson also commented that many small hospitals do not have staff dedicated solely to the program. “I have called numerous smaller hospitals across the Chicago area and asked who is in charge of their ASP. Oftentimes, it’s the director of pharmacy who states he or she is accountable,” Hanson said. “Given all of their administrative duties, it will be difficult for them to effectively lead a program.”

Therefore, ensuring that everyone involved is properly educated in antibiotic stewardship is essential. All staff who may be involved should receive appropriate training via online or live courses and dedicated time for daily activities in clinical antimicrobial stewardship. The Society of Infectious Disease Pharmacists offers a certificate program for hospital pharmacists to receive appropriate training to lead an ASP in a smaller hospital where, for example, pharmacists residency-trained in infectious disease may not be available.

For the full article, please visit for the March 2020 issue of Pharmacy Today.