Ron Small, Visante Senior Consultant, Executive Coach and Strategic Advisor, authored Chapter 2, Making a Business Case for Antifungal Stewardship in a recently released Joint Commission Resources (JCR) Guide. The JCR resource guide is available on the JCR website and is entitled, Antifungal Stewardship: A Practical Guide to Implementation.
According to JCR, “Antimicrobial stewardship has become an important initiative that promotes the appropriate use of all antimicrobial agents and prevents the development of microbial resistance to treatment. Some hospitals, due to services provided or patients served, would benefit to include antifungal stewardship within its stewardship program. This implementation manual defines the growing threat of invasive fungal disease as well as the business case for antifungal stewardship initiatives. Detailed direction for the development of an antifungal stewardship program, as well as measures to assess performance of the program are included in this manual.”
In Ron’s Chapter Introduction he observes that antibiotics have saved lives and transformed modern medicine, but they are becoming less effective, due to overuse and the development of multidrug resistant organisms (MDROs). Too often antibiotics are used inappropriately, putting patients at risk for developing antibiotic-resistant infections, C. difficile infections, as well as other clinical complications. The primary tenants of Antibiotic Stewardship Programs (ASPs) are to provide patients the right antibiotic, at the right time, at the right dose and duration of therapy that is streamlined and targeted to the infection being treated.
Antimicrobial Stewardship (AMS) and ASP have focused on the appropriate use of antibiotics while antifungal agents have received less attention. Antifungal stewardship (AFS) programs are being incorporated into existing AMS programs at many institutions because of the high cost of antifungal drugs and the specialized patients to whom they apply.
Ron shares that the goals of an antifungal stewardship program should include:
- Focus on ensuring the proper use of antimicrobials (antibiotics and antifungals)
- Provide the best patient outcomes
- Lessen the risk of adverse effects
- Promote cost-effectiveness
- Reduce or stabilize levels of microbial resistance
Ron also provides within the chapter the following as Tools for the Chapter Resource Kit:
- Systematic approach to business proposal development with a Sample Antifungal Stewardship Proposal
- Stewardship Gap Analysis Checklist
- Guide to Stakeholder Assessment
- Tips for communicating with the C-suite
This chapter identified the essential elements of AFS business case development including the following:
- Organizational Assessment of Antifungal Opportunities for Improvement (Gap Analysis)
- Factors to Consider in the Development of a Business Case for Antifungal Stewardship
- Planning Strategically for the Business Case Proposal
- Communicating with the C-Suite Leadership
- What Does Excellence Look Like?
Although antifungal resistance has been slow to emerge, compared to the breadth and frequency of bacterial resistance, there is every reason to believe this will become a widespread issue. Efforts to mitigate this trend will require a multifaceted approach as discussed in this chapter regarding making the business case for AFS. The high costs and high contribution of antifungal agents to the management of Invasive Fungal Disease along with their recognized toxicities is an important justification for AFS as outlined in this chapter.
The following link, https://www.jcrinc.com/antifungal-stewardship-a-practical-guide-to-implementation/#.XH9AzAMbzFg.emailmay be used to download the guide from the JCR website.